【作者】 马京华；

【导师】 赵玲；

【作者基本信息】 河北医科大学 ， 护理学， 2008， 硕士

【摘要】 目的:了解全省护理专业人力资源现状,包括护理人力资源数量、结构、教育、管理等情况。通过对现状的分析,揭示我省护理人力资源的特点及突出存在的问题,并提出解决问题的建议。为卫生行政部门贯彻落实《纲要》、制定相关护理政策提供科学的依据。研究方法:本研究采用问卷调查的方法,以填写调查表的形式进行。以河北省内二级及以上的综合医院作为调查对象,对医院的基本情况、护理人员数量、学历、职称、待遇进行描述性分析。所获数据录入Microsoft Excel电子表格建立的数据库,采用Spss14.0版统计软件进行数据处理。结果:共发放问卷203份,收回有效问卷201份,有效回收率为87.39%。其中三级医院22所,占三级医院总数的62.85%,二级医院179所,占二级医院总数的55.75%。201所医院共有卫生技术人员67,171人,其中医生数26,212人,占卫生技术人员的39.02%;护理人员27,490人,占卫生技术人员的40.92%;医技人员13,471人,占卫生技术人员20.05%。医院平均医护比为1:1.05,三级医院为1:1.19,二级医院为1:0.99,均低于国家卫生部规定的1:2的标准。护理人员结构比中临时护士占有一定比例,三级医院临时护士占护理人员总数的16.56%,位居最高;临时护理人员的学历层次和待遇与正式护理人员相比有显著性差异(p<0.05)。医院普通病区的床护比平均为1:0.35,三级医院为1:0.39,二级医院为1:0.32。按照1978年国家规定的1:0.4的标准,75.27%的医院为达标。重症监护病房床护比为1∶0.9,急诊观察室床护比为1∶1.07,与国家1:2~3的标准差距也较大。三级医院与二级医院护理人员缺编情况比较没有显著性差异(P>0.5),普通病房、监护室、急诊观察室缺编情况比较没有显著性差异(P>0.5),说明护理人员缺编现象普遍存在。从学历层次看,高学历层次人员数量偏低,中专学历占有较大比例。本科及以上学历、大专、中专以及无专业学历等各层次护理人员所占比例依次为7.90%、33.80%、44.80%和13.48%,三级医院本科及以上学历、大专、中专以及无专业学历等各层次护理人员所占比例依次为15.39%、37.81%、39.85%和6.94%,二级医院本科及以上学历、大专、中专以及无专业学历等各层次护理人员所占比例依次为4.04%、31.75%、47.36%和16.85%,护理人员高中低学历结构均呈现没有锐性的超扁平金字塔结构。三级医院护理人员的学历层次与二级医院相比有显著性差异(p<0.05)。从职称结构来看,以初级职称为主,具有高级职称护理人员的比例偏低,未定职称护理人员仍占有一定比例。副主任及主任护师、主管护师、护师和护士及未定职称各级职称护理人员所占比例依次为1.75%、29.96%、33.03%、26.45%和8.8%;三级医院副主任及主任护师、主管护师、护师和护士及未定职称各级职称护理人员所占比例依次为3.51%、39.16%、29.74%、2.42%和5.17%;二级医院副主任及主任护师、主管护师、护师和护士及未定职称各级职称护理人员所占比例依次为0.85%、25.21%、34.73%、28.53%和10.68%,护理人员职称结构均呈现没有锐性的超扁平金字塔结构。三级医院护理人员的职称结构与二级医院相比有显著性差异(P<0.05)。结果显示,各医院均不同程度的对护理人员进行在职培训,但只有52%的医院能较好的完成继续教育。继续教育的途径院内培训占77%,护理人员外出进修学习占11%。教育内容基础知识占75%,人文知识和专业技术分别占12%、13%。在职护理人员的培训没有因人而异,因专业而设,没有从工作年限、学历层次、职称等方面分层次、分步骤、有计划的进行;同时继续教育只注重形式,缺乏有效的评价和监督。医院的管理体制尚未完善,科主任负责制占76%;护理部的部分职能权利受到限制,护理部对护士聘用、护士长任免、护士调动等人事权不能很好的发挥其应有的职能作用。结论:通过对河北省护理人员现状调查分析发现:(1)河北省护理人力资源拥有量不足,医院护理人员缺编现象较显著;(2)高学历与高职称护理人才数量不足,与日益增长的护理服务需求不相适应;不能满足全省护理学科发展的需要。(3)聘用护士己成为河北省护理队伍的组成部分,且占有一定比例;卫生行政部门结合我国卫生人事制度改革的有关精神,制定聘用护士使用和管理的配套政策是加强护理人才队伍建设的关键;(4)医院的护理管理体制尚待完善,应将如何发挥护理部的管理职能,以提高护理人员积极性着手进行管理体制的改革。医院对护理人员在职继续教育重视不够。总之护理人员在数量和质量上难以满足人们日益增长的医疗保健需求。更多还原

【Abstract】 Objectives: To get a whole picture of the current nurse human resources in Hebei province, which includes the aspects of quantity, structure, education and management ect. As a result, the characteristics and prominent problems in nurses human resources management are presented, as well as some useful suggestions. Therefore scientific basis is provided for the administration of public health department to carry out the Formulates and to implement related policy.Methods: Questionnaire survey is applied in the study. The objects under investigation is 230 second level and above polyclinics in Hebei Province. Descriptive analysis is made, which includes the nursing stuffs, their education background, titles of technical post, benefits and general stata of investigated hospitals. Data is processed with SPSS for windows 14.0 statistic package.Results: 230 polyclinics are investigated, among which 201 questionnaires were valid and rate of recovery is 87.39%. The over all 201 hospitals involved 22 third level hospitals which takes 62.85% and 179 second level hospitals which takes 55.75% in all the hospitals.There are 67171 health professionals in which 26212(39.02%) are doctors, 27490(40.92%) are nursing, and 20.05% are medical care technicians. The average ratio of doctors and nurses in hospitals is 1:1.05, and the ratio is 1:1.19 in third level hospitals, 1:0.99 in second level hospitals, but both of them are lower than the standard 1:2. The temporary nursing staff takes a little percentage, with 16.56% in the third level hospitals which is the highest, but according to their level of educational background and the benefits are quite different from those of other hospitals(p<0.05); the formal has obvious superiority.The average bed/nurse ratio of common Patients’ wards in the hospitals is 1:0.35, and the ratio is 1:0.39 in third level hospitals and is 1:0.32 in second level hospitals. According to the national standard in 1987 which require the ratio up to 1:0.4, the nursing stuff is not enough in 75.27% hospitals; the bed/nurse ratio at Intensive Care Unit is 1:0.9 and the bed/nurse ratio in observation wards is 1:1.07, but each of that is lower than the standard 1:2.3. According to the nursing stuff shortage, there was no significant difference (P>0.5) between second level hospitals and third level hospitals, and also in common Patients’ wards、observation wards and Intensive Care Unit; there was no significant difference (P>0.5). It confirms that the lack of nursing stuff is a widespread question.As to the level of educational background, higher educated nurses are in need, while technical secondary school graduates account for the larger proportion. The ratio of education level: bachelor’s degree, junior college ,technical secondary school and under technical secondary school is 7.90%,33.80%,44.80%and 13.48% in nursing staffs; The ratio of education level: bachelor’s degree, junior college ,technical secondary school and under technical secondary school is 15.39%,37.81%,39.85%and 6.94% in third level hospitals; The ratio of education level: bachelor’s degree, junior college ,technical secondary school and under technical secondary school is 4.04%,31.75%,47.36%and 16.88% in second level hospitals; Sharp flat pyramidal structure of the educational level, which includes high, middle and low education, of nurses is not achieved. the staffs who received higher education in third level hospitals are more than who in second level hospital, there was significant difference (P<0.05).According to structure of titles of technical post, The number of elementary titles of technical post is high, but the top level titles of technical post is lack. The ratio of technical post: Chairman and vice-chairmen nurses, charge nurses , senior nurses ,junior nurses and no technical post is 1.75%,29.96%,33.03%, 26.45%and 8.8% in nursing staffs. The ratio of technical post:Chairman and vice-chairmen nurses, charge nurses , senior nurses ,junior nurses and no technical post is 3.51%,39.16%,29.74%,2.42% and 5.17% in third level hospitals; The ratio of technical post, Chairman and vice-chairmen nurses, charge nurses , senior nurses ,junior nurses and no technical post is 0.85%,25.21%,34.73%,28.53% and 10.68% in second level hospitals; Sharp flat pyramidal structure of the technical post, which includes high, middle and low technical post, of nurses is not achieved. Third level hospitals have many higher titles of technical post than second level hospitals. there was significant difference (P<0.05).As to the personal training and continuing education of nursing staffs, 52% hospitals only can complete the continuing education, which involes foundamental nursing knowledge (75%), Nurses have chance to go out for making an advanced study(11%).there are no training contents and scheme about culture and psychology,which the ratio is 12% and 13%. Continuing education of nursing staffs is not arranged by working year, education level and titles of technical post. Continuing education of nursing staffs only pays attention to the process and lacks effective assessment.The nurse management in hospital is not wholesome and nursing department can not function effectively and adequately,the system of dirctor respansible(76%).The function is very limited of the Nursing Department, and the rights to employ and promote nurses or remove the nurse are also limited.Conclusions: A conclusion has been made by current data analysis on nurse human resources. 1) The shortage of nurses in hospitals in Hebei province is obverious and sever; 2) The shortage of high educated and high title of technical post can’t meet development of nursing science as well as the increasing need of the patients; 3) The proportion of the temporary nurse staff is relative high, which indicates the key step of strengthen the nurse stuffs in hebei province is for the public health government to make the relative policy according to the spirit of public health reform in China. 4) The nurse management in hospital is not wholesome and nursing department can not function effectively and adequately,how exert the administer function of nursing department and progress innovation system of administer for improve positivity of nurses.Every level hospitals do not consider much of nurse’s continuing education. Thus the conslusion is that, the number and the character of nursing stuffs can’t meet the medical and health need of the public.更多还原