Upenieks Valda V, Akhavan Jaleh, Kotlerman Jenny
UCLA School of Nursing, Nursing Administration Graduate Program, Los Angeles, CA, USA.
Nurs Econ. 2008 Sep-Oct;26(5):294-300; quiz 301.
Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.
医疗保健成本的不断攀升使医院始终处于变革之中。因此，护理实践如今受到众多因素的影响，且一直处于持续变化的状态。过去20年里护士与患者比例以及一线护士构成的多次变化就是这种转变的例证。为了将护理实践重新构建为一个能够体现成本、质量和服务的经济等式，需要在思维上进行范式转变，以便评估工作重新设计。护理生产力必须根据增值护理来评估，这一理念超越了直接护理活动，包括团队协作、医生查房、增加注册护士与辅助人员之间的沟通以及以患者为中心；所有这些对于护士的角色和患者的福祉都至关重要。合理配置人员的科学取决于通过“系统理论”框架最能说明问题的系统变革的评估和实施。需要进行一次产出转换，以输入要素（一线护士数量）来创造流程变革，从而增加在增值护理上花费的时间，并减少浪费活动，提高效率、质量和服务水平。这项试点研究的目的有两个：（a）了解注册护士在增值护理上花费了多少时间；（b）与在必要任务和浪费上花费的时间相比，增加注册护士和无执照辅助人员的组合水平是否会增加在增值护理上花费的时间。
