van Oostveen Catharina J, Mathijssen Elke, Vermeulen Hester
Department of Quality Assurance & Process Innovation, Academic Medical Centre, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; Department of Surgery, Academic Medical Centre, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
Department of Quality Assurance & Process Innovation, Academic Medical Centre, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands; Clinical Health Sciences, Faculty of Medicine, Utrecht University, P.O. Box 85500, 3584 CG Utrecht, The Netherlands.
Int J Nurs Stud. 2015 Aug;52(8):1300-9. doi: 10.1016/j.ijnurstu.2015.04.002. Epub 2015 Apr 8.
To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS).
In response to rising health care demands due to ageing of the patient population and increasing complexity of healthcare, hospital boards have been implementing NPRs and PCSs. However, many nurses at the unit level believe that staffing levels have become critically low, endangering the quality and safety of their patient care.
This descriptive phenomenological qualitative study was conducted in a 1000-bed Dutch university hospital among 24 wards of four specialties (surgery, internal medicine, neurology, gynaecology & obstetrics and paediatric care). Data were collected from September until December 2012. To collect data four focus groups (n=44 nurses) were organized. Additionally, a total of 27 interviews (20 head nurses, 4 nurse directors and 3 quality advisors) were conducted using purposive sampling. The focus groups and interviews were audiotaped, transcribed and subjected to thematic analysis.
Nurse staffing issues appear to be merely the 'tip of the iceberg'. Below the surface three underlying main themes became clear - nursing behaviour, authority, and autonomy - which are linked by one overall theme: nurses' position. In general, nurses' behaviour, way of thinking, decision-making and communication of thoughts or information differs from other healthcare disciplines, e.g. physicians and quality advisors. This results in a perceived and actual lack of authority and autonomy. This in turn hinders them to plead for adequate nurse staffing in order to achieve the common goal of safe and high-quality patient care. Nurses desired a valid nursing care intensity system as an interdisciplinary and objective communication tool that makes nursing care visible and creates possibilities for better positioning of nurses in hospitals and further professionalization in terms of enhanced authority and autonomy.
The perceived subservient position of nurses in the hospital appears to be the root cause of nurse staffing problems. It is yet unknown whether an objective PCS to measure nursing care intensity would help them communicate effectively and credibly, thereby improving their own position.
深入了解荷兰护士对当前护士人员配备水平、护士与患者配比（NPR）及患者分类系统（PCS）的看法。
由于患者群体老龄化以及医疗保健复杂性增加，医疗保健需求不断上升，医院董事会一直在实施护士与患者配比及患者分类系统。然而，许多科室层面的护士认为人员配备水平已严重偏低，危及患者护理的质量和安全。
这项描述性现象学定性研究在一家拥有1000张床位的荷兰大学医院的四个专科（外科、内科、神经科、妇产科和儿科护理）的24个病房中进行。数据收集时间为2012年9月至12月。为收集数据，组织了四个焦点小组（共44名护士）。此外，采用目的抽样法进行了总共27次访谈（20名护士长、4名护士主任和3名质量顾问）。焦点小组讨论和访谈进行了录音、转录并进行了主题分析。
护士人员配备问题似乎仅仅是“冰山一角”。在表面之下，三个潜在的主要主题变得清晰——护理行为、权威性和自主性——它们由一个总体主题联系起来：护士的地位。总体而言，护士的行为、思维方式、决策以及思想或信息的交流与其他医疗保健学科（如医生和质量顾问）不同。这导致了一种在认知和实际中都存在的权威性和自主性的缺失。这反过来又阻碍了他们为获得充足的护士人员配备而据理力争，以实现安全和高质量患者护理的共同目标。护士们希望有一个有效的护理强度系统，作为一种跨学科的客观沟通工具，使护理工作可见，并为护士在医院中更好地定位以及在增强权威性和自主性方面进一步专业化创造可能性。
医院中护士被认为的从属地位似乎是护士人员配备问题的根本原因。目前尚不清楚一个用于衡量护理强度的客观患者分类系统是否会帮助他们进行有效且可信的沟通，从而改善他们自身的地位。
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