Nurses don't have enough nurses to help. Is it necessary to pay for nurses
'in addition to changing the dressing, come twice a day and say two words at a time & lsquo; Is your temperature normal & rsquo& lsquo; Ring the bell for something. " On October 24, Zhang Shuo, a family member of a pneumonia patient, complained in the respiratory ward of a specialized hospital in Shenyang.
He didn't know that Li Lili, the responsible nurse on the day shift, was responsible for six patients. On the same day, in addition to injection and medication, she visited the room to observe the patient's condition and infusion, and also wrote nursing records, blood preparation and blood collection. Two new patients were admitted and a critically ill patient was escorted out for examination. He was so busy that he didn't even drink water when he got off work.
By the end of 2018, there were more than 4 million registered nurses in China. According to the survey report on the development status of nurses in China, 94.1% of the respondents believed that the highest proportion of nurses' work content was injection and medication, but they did not know the specific work of nurses. Many patients and their families even feel that nursing workers hired at high prices have replaced nurses. Why?
'you can't take good care of the patient. Why don't you hire a nurse'
On October 21, Zhang Shuo's mother suddenly had difficulty breathing and mild dehydration. After being sent to the hospital for treatment at 9:00, he was diagnosed with pneumonia. The nurse asked how to go through the formalities, infuse several times a day and take the medicine several times before it 'disappeared'. When asked about the price of nursing workers, the cheapest one costs 200 yuan a day. Zhang Shuo can only ask for 7-day annual leave to care for her mother. She has no nursing experience. In the face of her mother with poor breathing, how appropriate is the angle of raising the hospital bed, how to help clean up respiratory secretions, whether she can pat her back when coughing, whether she needs 24-hour oxygen inhalation, and whether the amount of oxygen can be adjusted. Zhang Shuo 'rings the Bell' to ask the nurse for help with more than 10 questions every day. Finally, the two sides broke out and quarreled.
'you can't take good care of the patient. Why don't you hire a nurse?' I pay for a nurse. What's the nurse doing? " Li Lili believes that most of the problems Zhang Shuo asks for help are life nursing, which is not within her job responsibilities. If time permits, she is willing to carefully guide Zhang Shuo on how to care, but there are severe patients waiting for her to escort them for examination. Zhang Shuo believes that the inpatient payment project includes' nursing fee ', and nurses should implement doctors' orders and do a good job in basic nursing and specialized nursing for patients, resulting in contradictions.
The regulations on nurses implemented in 2008 pointed out that nurses refer to health technicians who have obtained a nurse practice certificate through practice registration, engage in nursing activities, and perform the duties of protecting life, alleviating pain and improving health. In 1978, the principles for the organization and staffing of general hospitals (Trial draft) issued by the former Ministry of health stipulated that the ratio of hospital beds to nurses in medical and health institutions shall not be less than 1:0.4. However, 41 years later, the bed care ratio of general wards in tertiary hospitals is still a 'reference standard' that is difficult to implement.
In reality, many patients and their families who face the same dilemma as Zhang Shuo choose to hire nursing workers. However, practitioners in the nursing industry are mixed, and it is difficult to reach the professional level of nurses. " I looked at my breathing and pulled it out. " Last December, when the nurses of the hospital visited the room after the shift change, they found that there was no ventilator intubation, oxygen tube or humidification tube on the endotracheal intubation of a post-operative coma patient. The nurse immediately connects the patient to the ventilator as quickly as possible. If the patient's blood oxygen saturation does not meet the standard, it will be life-threatening. Later, it was found that the nurse pulled it out without permission, because she looked at the patient and breathed well, and the nurse had worked for three years.
Jiang Yan, head nurse of a third class hospital ward in Shenyang, told reporters that nursing workers can not replace nurses. Medical nursing is not only injection and medication, but also nursing prescription, rehabilitation guidance, psychological counseling and so on. In clinical practice, nurses also play the roles of intensive care, infection control and emergency first aid, while nursing workers are just caregivers of life. " The former requires disinfection and sterilization, while the latter is inevitably exposed to bacteria due to the nature of work. No hospital will allow a person to give an injection after defecating a patient, so nursing workers and nurses can't replace each other. "
Difficult to implement without accompanying ward
In view of the high price of nursing workers, people's inability to afford and frequent medical disputes, in 2010, the state issued the high quality nursing service standard (Trial), requiring tertiary hospitals to comprehensively promote high-quality nursing services. The purpose is to 'care for patients without relying on their families or self employed nursing workers by their families, significantly reduce the accompanying rate', and reduce the nursing expenditure of hospitalized patients and the burden of their families. However, it is difficult to implement this kind of 'unaccompanied ward'.
"They do as many jobs as nursing workers, but their income is twice as bad." Wang Bo was a male nurse in the emergency department of a second class hospital in Shenyang. 1600 yuan per month in the first year and 3000 yuan per month in the third year. In contrast, nursing workers who have only received simple training can earn 6000 yuan a month after working for three years. " At least I'm also a graduate of a serious University. I can't even afford a house. " Chen Wanjun, director of the nursing department, told reporters that there were 107 nurses in the hospital, with an average of one nurse taking care of 6 patients. Last year, 20 nursing college students were recruited and 10 went, with an annual turnover rate of 10%.
The survey report on the development status of nurses in China shows that 77.5% of nurses' monthly income is less than 5000 yuan and 37.6% is less than 3000 yuan.
The hospital has studied the implementation of & lsquo; Quality care & rsquo;, Each patient is required to have & lsquo; Bed nurse & rsquo; Be responsible for the whole process, from patrol inspection and observation of patients three times a day to psychological and health education of patients. Even if patients and their families are unwilling to hire nursing workers, life nursing nurses such as feeding, turning over and brushing should also help. " This has undoubtedly doubled the workload, but the salary has not changed. " Wang Bo said. Finally, it was opposed by all the nurses in the hospital and could only be implemented in the intensive care unit.
The prevalence of the concept of "emphasizing medical treatment and neglecting nursing" in hospitals has also hurt the hearts of nurses. " Hiring nurses is losing money but not making money. They can neither attract patients to see a doctor like experts, nor like ordinary doctors & lsquo; Square & rsquo; Bring benefits. Many hospitals treat nurses as service personnel, which is also & lsquo; Reduce staff and increase efficiency & rsquo; Preferred. " Chen Wanjun said.
Nursing workers are staff employed by patients or family members in the hospital to assist nurses in daily nursing and help patients. With the shortage of nurses, it is inevitable to force patients and their families to hire nursing workers.
Why is the skill level worse than nurses, but earn more than nurses? Chen Wanjun explained: 'most of the nursing workers need 24-hour close care. The labor intensity is high, and no one is willing to do it. Under the market regulation, the price should be high. The post of nurse is within the establishment, the nursing fee has not increased for many years, and the salary increase is slow. And some & lsquo; Contract nurse & rsquo;, The salary is very low. Therefore, the contrast is prominent. "
Two pronged approach can be effective
"It is imperative to adjust the nursing fee." Jiang Yan believes that the unreasonable setting of nursing fee is the root of the problem. At present, the government investment in medical resources is insufficient, the hospital operation can only barely maintain, and it is difficult to raise the salary of nurses. This leads to the shortage of nurses, the difficulty of popularizing high-quality nursing and the confusion of nursing management. Therefore, it is imperative to adjust the nursing fee.
"The adjustment is not random or average growth, but should take into account the burden of the people and difficult jobs." Jiang Yan said. She suggested that part of the adjusted nursing expenses should be included in the medical insurance, and the government should reduce the nursing economic burden of patients and their families. At the same time, relevant departments scientifically calculated the nursing fee price according to nurses in different posts, and adjusted it reasonably in stages.
Incentives are equally important. Wang Bo believes that hospitals at all levels should establish an incentive mechanism in which the workload, labor intensity, technology and risk are directly proportional to income, promotion and other benefits, and a distribution mechanism in which the labor value and remuneration match.
In the case of insufficient nurses, strengthening the supervision of nursing industry and improving the skill level of nursing workers are the key to solve the problem. Jiang Yanfeng, chairman of the industrial group of Shenyang women's army housekeeping service company, suggested that the government classify and train nursing workers in stages, and distinguish professional nursing workers from ordinary nursing workers. For ordinary nursing workers who take care of patients' daily life, they only need to judge the potential risks and ask medical and nursing personnel for help in time, and the civil affairs department can give training subsidies. For medical and nursing personnel who need professional skill training, improve the medical and nursing level through continuing education and higher vocational colleges.
Source: workers daily