长期护理中单站点医嘱的影响：加剧系统负担。
Impact of the single site order in LTC: exacerbation of an overburdened system.
机构信息
School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada.
Center for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
出版信息
BMC Health Serv Res. 2023 Jun 20;23(1):666. doi: 10.1186/s12913-023-09670-7.
BACKGROUND
The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC homes in the Lower Mainland of British Columbia, Canada.
METHODS
A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 - March 2020) and four quarters during the pandemic (April 2020 - March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis.
RESULTS
Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO.
CONCLUSIONS
The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed.
背景
长期护理（LTC）部门一直是加拿大 COVID-19 的中心。本研究旨在了解不列颠哥伦比亚省低陆平原的四个长期护理院中单一地点订单（SSO）对员工和领导层的影响。
方法
采用混合方法研究，通过分析行政人员配置数据进行研究。从四个季度（2019 年 4 月至 2020 年 3 月）之前和四个季度（2020 年 4 月至 2021 年 3 月）期间提取和分析了加班、人员流动和职位空缺数据，使用散点图和两部分线性趋势线，针对总直接护理护理人员和指定人员（即注册护士（RNs）、持牌实习护士（LPNs）和护理助手（CAs））进行分析。对来自四个合作伙伴护理院的每个护理院的领导层（10 名）和员工（18 名）进行了有针对性的虚拟访谈（n=28）。在 NVivo 12 中使用主题分析对转录本进行了分析。
结果
定量数据表明，总加班率从大流行前增加到大流行期间，注册护士的增长率最高。此外，尽管所有直接护理护理人员的自愿离职率在大流行前呈上升趋势，但在大流行期间，LPN 和最急剧的是 RN 的离职率更高，而 CA 的离职率下降。定性分析确定了两个主要主题和子主题：（1）加班（员工流失、心理健康和病假）和（2）员工离职（培训新员工的需求，以及性别/种族）是与 SSO 相关的最显著影响。
结论
本研究结果表明，由于 COVID-19 和 SSO 造成的结果在护理指定人员中并不均等，长期护理部门的注册护士短缺非常明显。定量和定性数据强调了大流行和相关政策对长期护理部门的重大影响，即员工工作过度，护理院人手不足。
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