Rozdilsky Janlyn, Alecxe Amber
Research to Action Project, Saskatoon, SK.
Nurs Leadersh (Tor Ont). 2012 Mar;25 Spec No 2012:103-13. doi: 10.12927/cjnl.2012.22802.
The issue of nurse-to-patient ratios has been of significant interest to nurses in Saskatchewan. A commitment to a nurse-to-patient pilot project was articulated in a letter of understanding in the 2005 to 2008 contract between the Saskatchewan Union of Nurses (SUN) and the Saskatchewan Association of Health Organizations. The SUN, the Saskatoon Health Region and the Saskatchewan Ministry of Health formed a partnership to engage in the pilot project, which lasted from November 2008 to March 2011. The project involved the creation of a flexible, dynamic and real-time staffing tool to inform day-to-day nurse staffing decisions on a hospital unit and was based on an adaptation of Curley's Synergy Model. A medical unit at St. Paul's Hospital in Saskatoon was selected for implementation, and all front-line nursing staff as well as unit nursing leaders were involved. A project working group adapted the Synergy-based Patient Scoring Tool (PST), which had been utilized for a recent project in British Columbia, to its own patient population. In April 2010, nurses began assessing each patient on every shift with the goal of determining the most suitable care provider. Patient assignment became based on the holistic assessment of patient needs according to the PST results rather than "geography" (for example, one nurse assigned to a multi-bed unit regardless of the acuity/capability of patients in the unit). Whenever possible, staffing on the unit was increased according to tool calculations.Positive impacts in patient outcomes began to be noted during the final data collection period for the project – nosocomial infection rates showed improvement, and the number of falls per patient-days decreased. As well, patient needs were made more visible through use of the PST, which created non-threatening opportunities for dialogue related to legislated scopes of practice. While longer timelines and larger sample size are needed to measure impacts on retention and recruitment of nurses, nurses in the project demonstrated increased engagement over the study period. The tools and processes developed in this project are adaptable to other patient populations and care settings.
护士与患者的配比问题一直是萨斯喀彻温省护士们极为关注的焦点。在2005年至2008年萨斯喀彻温省护士联盟（SUN）与萨斯喀彻温省卫生组织协会签订的谅解书中，明确表达了开展护士与患者配比试点项目的承诺。SUN、萨斯卡通卫生区域和萨斯喀彻温省卫生部建立了合作伙伴关系，共同参与该试点项目，项目从2008年11月持续至2011年3月。该项目旨在创建一个灵活、动态且实时的人员配置工具，为医院科室的日常护士人员配置决策提供依据，其基于对柯利协同模型的改编。萨斯卡通圣保罗医院的一个医疗科室被选定用于实施该项目，所有一线护理人员以及科室护理负责人都参与其中。一个项目工作组对基于协同作用的患者评分工具（PST）进行了调整，该工具曾在不列颠哥伦比亚省的一个近期项目中使用，以适用于其自身的患者群体。2010年4月，护士们开始在每个班次对每位患者进行评估，目的是确定最合适的护理人员。患者分配基于根据PST结果对患者需求的全面评估，而不是“地理位置”（例如，一名护士被分配到一个多床位科室，而不考虑该科室患者的病情严重程度/能力）。只要有可能，就会根据工具计算增加科室的人员配置。在项目的最终数据收集阶段，开始注意到对患者结果产生了积极影响——医院感染率有所改善，每患者日跌倒次数减少。此外，通过使用PST，患者需求变得更加明显，这为与法定执业范围相关的对话创造了无威胁的机会。虽然需要更长的时间跨度和更大的样本量来衡量对护士留用和招聘的影响，但该项目中的护士在研究期间表现出更高的参与度。该项目开发的工具和流程可适用于其他患者群体和护理环境。
