比率与护士人员配置：急诊科的棘手情况。
Ratios and nurse staffing: the vexed case of emergency departments.
作者信息
Wise Sarah, Fry Margaret, Duffield Christine, Roche Michael, Buchanan John
机构信息
Faculty of Health, University of Technology, Level 7, 235-253 Jones Street, PO Box 123, Broadway, NSW 2007, Australia.
Northern Sydney Local Health District, NSW Health, Level 7 Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
出版信息
Australas Emerg Nurs J. 2015 Feb;18(1):49-55. doi: 10.1016/j.aenj.2014.08.001. Epub 2014 Sep 16.
BACKGROUND
Within Australia nursing unions are pursuing mandated nurse-patient ratios to safeguard patient outcomes and protect their members in healthcare systems where demand perpetually exceeds supply. Establishing ratios for an emergency department is more contentious than for hospital wards. The study's aim was to estimate average staffing levels, skill mix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs).
METHODS
The design was a retrospective historical census audit. Nurse rosters and patient presentation data were collected for three randomly selected census days in May 2010. Twenty-six valid responses out of 44 were returned. A ratio of the number of beds per nurse was calculated as well as skill mix and bed occupancy.
RESULTS
The average beds per nurse ratios found were 3.8 (morning shift), 3.6 (evening), and 5.1 (night). However, ratios as high as 8.4 (morning), 7.3 (evening) and 16.0 (night) were identified on particular shifts. Overall a rich skill mix was found with an average of 90% of nursing hours being provided by Registered Nurses. The average daily bed occupancy of 4 patients per bed was similar across ED levels.
CONCLUSIONS
The study adds to the limited literature on ED staffing and demonstrates the utility in the simplicity of ratios in flagging potential staffing problems. The audit revealed wide variation in staffing levels which was not always linked to patient activity. Of particular concern were the regional EDs (Level 5) which have the capacity to deal with all types of emergencies but where ratios as high as 7 beds per nurse were found during the day. Ratios cannot be used to determine the optimal staffing levels in every clinical situation; their purpose is to force an increase in nursing supply and to prevent individual units from becoming understaffed.
背景
在澳大利亚，护理工会正在争取法定的护士与患者配比，以保障患者治疗效果，并在需求长期超过供给的医疗系统中保护其成员。确定急诊科的配比比医院病房更具争议性。该研究的目的是估算新南威尔士州（NSW）所有急诊科的平均人员配备水平、技能组合和患者就诊情况。
方法
采用回顾性历史普查审计设计。收集了2010年5月随机选取的三个普查日的护士排班表和患者就诊数据。44份问卷中返回了26份有效回复。计算了每名护士的床位比以及技能组合和床位占用情况。
结果
发现每名护士的平均床位比为：早班3.8，晚班3.6，夜班5.1。然而，在特定班次发现比例高达早班8.4、晚班7.3和夜班16.0。总体而言，技能组合丰富，注册护士提供的护理时长平均占90%。各急诊科的平均每日每张床位4名患者的床位占用情况相似。
结论
该研究补充了关于急诊科人员配备的有限文献，并证明了配比在标记潜在人员配备问题方面的简单实用性。审计显示人员配备水平差异很大，且并不总是与患者活动相关。特别令人担忧的是地区急诊科（5级），它们有能力处理各类紧急情况，但白天发现每名护士的床位比高达7张。配比不能用于确定每种临床情况下的最佳人员配备水平；其目的是促使增加护理人员供给，并防止个别科室人员不足。
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