Milken Institute School of Public Health, George Washington University, Washington, DC.
Mathematica Policy Research, Princeton, NJ.
Nurs Outlook. 2018 Jan-Feb;66(1):35-45. doi: 10.1016/j.outlook.2017.06.014. Epub 2017 Jul 21.
Despite the large numbers in health care industry, little is known about the clinical nonlicensed personnel (CNLP) in U.S. hospitals and how their staffing has changed over time.
The purpose of this analysis is to better understand the conformation and recent trends in CNLP staffing in U.S. hospitals from 2010 to 2015.
Using Premier's OperationsAdvisor database, we examined trends in staffing of 25 CNLP jobs and graduate nurses (GNs) in U.S. hospitals and by hospital units, including medical-surgical units, outpatient units, and emergency departments, from 2010 to 2015, based on their skill levels. We measured CNLP and graduate nurse staffing using the average number of full-time equivalents (FTEs) in each hospital. We performed statistical analysis to compare the changes in the number of FTEs between 2010 and 2015.
Over the 6-year period from 2010 to 2015, we observed declining trends in the average number of high-skill and middle-skill CNLP FTEs by 22% and 7%, respectively, and increases in the average number of low-skill and graduate nurse FTEs by 38% and 117%, respectively. This skill mix shift appears to be most pronounced in emergency departments.
Changes in staffing levels and the skill mix of the hospital workforce warrant further study to understand both the reasons behind the observed changes and their effects on health outcomes. Although labor efficiency is an important goal, it is also critically important to assess whether reductions and/or the skill mix shifts among support staff impact nurse workload and, by extension, patient safety.
尽管医疗保健行业的人数众多，但人们对美国医院的临床非持照人员（CNLP）知之甚少，也不知道他们的人员配备随时间发生了怎样的变化。
本分析旨在更好地了解 2010 年至 2015 年美国医院 CNLP 人员配备的构成和近期趋势。
利用 Premier 的 OperationsAdvisor 数据库，我们根据技能水平，检查了 2010 年至 2015 年美国医院 25 个 CNLP 工作岗位和研究生护士（GN）的人员配备趋势，以及按医院科室（包括内科-外科病房、门诊和急诊部门）划分的人员配备趋势。我们使用每个医院的全职等效人员（FTE）的平均数量来衡量 CNLP 和研究生护士的人员配备。我们进行了统计分析，以比较 2010 年至 2015 年之间 FTE 数量的变化。
在 2010 年至 2015 年的 6 年期间，我们观察到高技能和中技能 CNLP FTE 的平均数量分别下降了 22%和 7%，而低技能和研究生护士 FTE 的平均数量分别增加了 38%和 117%。这种技能组合的转变在急诊部门似乎最为明显。
医院劳动力人员配备水平和技能组合的变化需要进一步研究，以了解观察到的变化背后的原因及其对健康结果的影响。尽管劳动效率是一个重要目标，但评估支持人员的减少和/或技能组合转变是否会影响护士工作量，以及由此对患者安全产生影响也同样至关重要。
