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The Healthcare Workforce Shortage of Nurses and Physicians: Practice, Theory, Evidence, and Ways Forward. 护士和医生的医疗保健劳动力短缺:实践、理论、证据和前进之路》。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-10-13 DOI: 10.1177/15271544241286083
Daniel Tobias Michaeli, Julia Caroline Michaeli, Sebastian Albers, Thomas Michaeli

The healthcare sector is ubiquitously plagued by workforce shortages in economies around the globe. The fragility of this structural shortage becomes apparent when external shocks, such as the COVID-19 pandemic, exacerbate the lack of workers in clinical practice. In this article, we summarize current trends in healthcare workforce development across the globe, review theoretical concepts of workforce shortages, and discuss policies to address them. In practice, developed countries often address workforce shortages with targeted migration policies. However, targeted workforce migration policies only intensify workforce shortages in low-and middle-income countries. Theoretical macroeconomic models suggest that supply shortages may result from too low wages, supply lagging behind demand, and social perception. Changes in the wage rate cannot sufficiently increase the supply of health professionals as scholars find inelastic wages for physicians and nurses. Nonpecuniary factors such as working conditions, job satisfaction, and intrinsic motivation are at least equally important as financial incentives. In conclusion, increased wages can only be part of a heterogeneous policy plan to address shortages. Migration and retirement levels of health professionals can temporarily mitigate workforce shortages but rarely change the underlying systemic issues. Increasing the number of places available in medical and nursing schools while also improving, both, financial and nonfinancial incentives for employees are long-term structural policy options.

在全球各经济体中,医疗保健行业普遍受到劳动力短缺的困扰。当 COVID-19 大流行等外部冲击加剧了临床实践中工作人员的缺乏时,这种结构性短缺的脆弱性就会显现出来。在本文中,我们总结了当前全球医疗保健劳动力发展的趋势,回顾了劳动力短缺的理论概念,并讨论了解决这些问题的政策。在实践中,发达国家通常通过有针对性的移民政策来解决劳动力短缺问题。然而,有针对性的劳动力迁移政策只会加剧中低收入国家的劳动力短缺问题。理论上的宏观经济模型表明,工资过低、供应落后于需求以及社会观念都可能导致供应短缺。由于学者们发现医生和护士的工资缺乏弹性,因此工资率的变化不足以增加卫生专业人员的供应。工作条件、工作满意度和内在动力等非金钱因素至少与经济激励同等重要。总之,增加工资只能是解决短缺问题的多元化政策计划的一部分。卫生专业人员的迁移和退休水平可以暂时缓解劳动力短缺问题,但很少能改变根本的系统性问题。增加医学院校和护理学校的招生名额,同时改善对员工的经济和非经济激励,是长期的结构性政策选择。
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引用次数: 0
Utilizing Federal Data Sources to Support Nursing Workforce Analysis. 利用联邦数据源支持护理人员队伍分析。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-10-22 DOI: 10.1177/15271544241286078
Byunggu Kang, Theekshana Fernando, Jinman Pang, Peter Shirey, David P Armstrong

Effective health workforce analysis requires robust data and information. Quality data facilitate monitoring workforce trends, identifying shortages, forecasting employment needs, and planning educational programs. A wide range of federal agencies collect various forms of data, including administrative data, surveys, and censuses, which can be used for health workforce analysis. However, identifying the most appropriate data sources to address a specific nursing workforce issue can be challenging, particularly for newcomers to the field or those researching unfamiliar topics. In this article, we introduce and review 18 federal data sources pertinent to nursing workforce analysis. We categorize the datasets by their associated federal agency, describe each source, discuss their applicability to nursing workforce studies, present examples of past studies that employed these datasets, and highlight their limitations. Our aim is to help researchers, policymakers, and healthcare administrators efficiently locate and leverage relevant data for their analysis.

有效的医务人员队伍分析需要强有力的数据和信息。高质量的数据有助于监测劳动力趋势、确定短缺情况、预测就业需求和规划教育计划。许多联邦机构都会收集各种形式的数据,包括行政数据、调查和人口普查,这些数据可用于卫生劳动力分析。然而,确定最合适的数据来源以解决特定的护理人员问题可能具有挑战性,尤其是对于该领域的新手或研究不熟悉主题的人员而言。在本文中,我们介绍并回顾了与护理人员分析相关的 18 个联邦数据源。我们将这些数据集按其相关的联邦机构进行分类,描述每个数据源,讨论它们对护理人员研究的适用性,介绍过去使用这些数据集进行研究的实例,并强调它们的局限性。我们的目的是帮助研究人员、政策制定者和医疗保健管理者有效地找到并利用相关数据进行分析。
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引用次数: 0
National Nursing and Midwifery Commission Act, 2023 in India: Issues and the Way Forward. 印度《2023 年国家护理和助产士委员会法》:问题与前进之路》。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2024-08-20 DOI: 10.1177/15271544241271422
Surya Kant Tiwari, Geetanjali Kalyan, Kannemadugu Silpa, L Levis Murry, Poonam Joshi

With the recent enactment of the National Nursing and Midwifery Commission (NNMC) Act, 2023, significant changes are anticipated in the scope of practice and autonomy for registered nurses and midwives in India. However, alongside these anticipated advancements, concerns have emerged regarding various aspects of the Act, necessitating critical examination. In this article, we aim to explore expected changes in nursing education and service and concerns about the NNMC Act, providing insights into the implications of the NNMC Act on the regulation and advancement of the nursing and midwifery profession in India. The Act is anticipated to introduce uniform standards, implement entry and exit examinations, recognize midwifery as a distinct discipline, and determine the scope of practice for nurses and midwives. Moreover, the implementation of the Nurse Practitioner Program and guidelines for its limited prescribing authority is anticipated. Concerns exist regarding the composition of the commission and board members, adequate stakeholder representation, lacking provisions for ensuring continued competence, working conditions of nurses and midwives, nomenclature, integrating new terms, and clearly defining roles. These concerns emphasize the need for viable career pathways, uniform cadres, and a streamlined registration system, crucial for advancing nursing and midwifery profession in India. The coexistence of concerns and anticipation highlights the complexity of enacting regulatory reforms in nursing and midwifery. Policymakers can lay the foundation for a comprehensive, inclusive regulatory system that promotes excellence in nursing and midwifery practice, ultimately benefiting both healthcare providers and patients.

随着最近《2023 年国家护理和助产委员会法案》的颁布,预计印度注册护士和助产士的执业范围和自主权将发生重大变化。然而,在这些预期进步的同时,该法案的各个方面也出现了令人担忧的问题,需要进行严格审查。在本文中,我们旨在探讨护理教育和服务方面的预期变化以及对《国家护士和助产士管理法》的担忧,深入探讨《国家护士和助产士管理法》对印度护理和助产专业的监管和发展的影响。预计该法案将引入统一标准,实施入职和离职考试,承认助产是一门独特的学科,并确定护士和助产士的执业范围。此外,预计还将实施执业护士计划及其有限处方权准则。人们对委员会和理事会成员的组成、利益相关者的充分代表性、缺乏确保持续能力的规定、护士和助产士的工作条件、术语、新术语的整合以及角色的明确界定等问题表示关切。这些关切强调了可行的职业发展途径、统一的干部和简化的注册制度的必要性,这对推动印度护理和助产专业的发展至关重要。担忧与期待并存,凸显了护理和助产监管改革的复杂性。政策制定者可以为建立一个全面、包容的监管体系奠定基础,从而促进护理和助产实践的卓越发展,最终使医疗服务提供者和患者受益。
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引用次数: 0
Costs Saved by Visiting a Nurse-Led Primary Care Facility Comparison of Primary Care Models. 到护士领导的初级保健机构就诊所节省的费用 初级保健模式比较。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2024-05-06 DOI: 10.1177/15271544241247767
Loren P Wagner PhD, Bev Zabler PhD Rn

Introduction: Nurse-led primary care is a relatively rare model for primary care, but given nurses more holistic approach to medicine, can prove effective in both reducing costs and disparities in access and outcomes. The present study compares cost adjusted quality of care between a nurse-led primary care facility and the standard primary care.

Design: To compare the cost adjusted quality of care between the standard primary care model and a nurse led primary care model the outcomes from a population of patients that visited each (control and experimental, respectively) are compared with respect to three complications of hypertension (stroke, heart attack, and coronary heart disease).

Method: The number of three complications (stroke, heart attack, and coronary artery disease) from hypertension for the experimental population is estimated using time-to-event distributions estimated from the control population. Costs are estimated using the control population data.

Results: It is found that the population that visited the nurse-led primary care facility had better cost adjusted outcomes than the population that visited the physician led facilities. We can attribute, at least, $3.7 million in costs not realized due to the quality of care provided by the nursing center.

Conclusion: Nurse-led primary care is one way that the U.S. healthcare system could reduce costs while providing consistent quality of care.

导言:以护士为主导的初级保健是一种相对罕见的初级保健模式,但由于护士采用了更全面的医疗方法,因此可以有效降低成本,减少就医机会和结果方面的差异。本研究比较了以护士为主导的初级医疗机构和标准初级医疗机构的成本调整后医疗质量:为了比较标准初级医疗模式和护士主导初级医疗模式的成本调整后医疗质量,我们比较了就诊患者(分别为对照组和实验组)在三种高血压并发症(中风、心脏病发作和冠心病)方面的结果:方法:根据对照组人群的时间-事件分布估算实验组人群高血压三种并发症(中风、心脏病和冠心病)的数量。使用对照人群的数据估算成本:结果:我们发现,到护士领导的初级保健机构就诊的人群比到医生领导的机构就诊的人群有更好的成本调整结果。由于护理中心提供的护理质量,我们至少可以归因于 370 万美元的成本没有实现:护士主导的初级医疗是美国医疗系统在提供稳定的医疗质量的同时降低成本的一种方法。
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引用次数: 0
Policy Reform on the Qualification Pathway of Internationally Educated Nurses in Greenland and Its Relationship With the Danish System: A Qualitative Discourse Analysis. 格陵兰国际教育护士资格途径的政策改革及其与丹麦制度的关系:定性话语分析》。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2024-04-24 DOI: 10.1177/15271544241245975
Floro Cubelo

The nursing profession in Greenland, particularly in rural and remote areas, faces challenges due to geographical limitation and a lack of interdisciplinary collaboration. The registration process and status of internationally educated nurses (IENs) in Greenland are unclear. This article aimed to analyze existing policies and propose recommendations for an independent registration process for IENs in Greenland. A qualitative discourse analysis was used to critically discuss existing policies and regulations governing nursing registration in Greenland. Relevant legislation, government reports, and official documents were reviewed. Legislative regulations protect the title of registered nurse in both Greenland and Denmark. To work in Greenland, an IEN must have a residence permit. With recent health agreements between Greenland and Denmark, both countries have streamlined the permit acquisition process for foreign healthcare professionals, making it more accessible. However, the process of acquiring a license to work as a registered nurse for IENs lacks clarity. Policy reform is needed to establish a group of diverse nurse experts under the National Board of Health responsible for the assessment and registration of IEN qualifications. There is also a need for a bridging education program or national licensure examination which could facilitate faster IEN recognition. Mutual recognition of nurse licenses between Greenland and Denmark should be established to ensure efficient healthcare delivery and maintain professional standards. Embracing IENs can address nursing shortages and improve healthcare services in Greenland.

格陵兰的护理专业,尤其是农村和偏远地区的护理专业,由于地理位置的限制和缺乏跨学科合作而面临挑战。格陵兰受过国际教育的护士(IENs)的注册程序和地位尚不明确。本文旨在分析现有政策,并就格陵兰国际教育护士的独立注册程序提出建议。文章采用定性话语分析的方法,对格陵兰现有的护士注册政策和法规进行了批判性讨论。对相关立法、政府报告和官方文件进行了审查。格陵兰和丹麦的法律法规都保护注册护士的头衔。要在格陵兰工作,国际注册护士必须持有居住证。随着格陵兰和丹麦最近签订卫生协议,两国都简化了外国医疗保健专业人员的许可证获取程序,使其更容易获得。然而,国际移民申请注册护士执照的程序不够明确。需要进行政策改革,在国家卫生委员会下设立一个由不同护士专家组成的小组,负责评估和注册 IEN 资格。此外,还需要开展衔接教育计划或全国执照考试,以加快对 IEN 的认可。格陵兰和丹麦应相互承认护士执照,以确保高效的医疗保健服务并保持专业标准。接受国际护士执照可以解决格陵兰的护士短缺问题并改善医疗保健服务。
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引用次数: 0
War Is a Public Health Problem. 战争是一个公共卫生问题
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1177/15271544241265794
Christine Kovner
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引用次数: 0
Nurses as Petitioners: A Legal Mapping of State Extreme Risk Protection Order Laws. 护士作为请愿人:各州极端风险保护令法的法律图谱。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2024-07-26 DOI: 10.1177/15271544241262744
Lisa C Lindley, Christina N Policastro, Radion Svynarenko, Heather A Davis, Lora Humphrey Beebe

Gun violence is a leading public health concern in the US; subsequently, firearm-related violence prevention is a top priority for policymakers. Extreme risk protection order (ERPO) laws are a state-level attempt to reduce gun-related injuries and deaths. These court-issued orders prohibit people found to be dangerous to themselves or others from temporarily purchasing or possessing a firearm. Six states (Colorado, Connecticut, Hawaii, Maryland, Michigan, New York) and the District of Columbia have passed or amended their laws to include nurses as ERPO petitioners. The study's purpose was to conduct a review of state ERPO laws that included nurses as petitioners. Using a legal mapping approach, information on nurse ERPO petitioning was extracted from the seven jurisdictions. ERPO laws with nurse petitioners were passed between 1999 and 2023. Nurse petitioners included advanced practice registered nurse (n = 3), clinical nurse specialists (n = 3), nurse practitioner (n = 3), professional nurse (n = 2), and register nurse (n = 1). Psychiatric/mental health (n = 2) and school nurses (n = 2) were specified. Statutes differed in the handling of disclosed health information as part of the ERPO petition, as well as how health information would be handled by the court (e.g. sealed by the court, confidential by the court, returned to provider/disposed of post-hearing/order.) Three statutes exempted petitioners from civil and/or criminal liability, if petitions were submitted in good faith. Two of these states extended protection from liability to all petitioners, while one only referenced petitioners who were healthcare providers. The study findings have important policy, clinical, and research implications.

枪支暴力是美国主要的公共健康问题;因此,预防与枪支有关的暴力是政策制定者的首要任务。极端风险保护令 (ERPO) 法律是州一级为减少与枪支有关的伤亡而做出的尝试。这些由法院签发的命令禁止被认定对自己或他人有危险的人暂时购买或拥有枪支。六个州(科罗拉多州、康涅狄格州、夏威夷州、马里兰州、密歇根州、纽约州)和哥伦比亚特区已经通过或修订了法律,将护士列为ERPO申请者。本研究的目的是对将护士列为申请人的各州ERPO法律进行审查。通过法律地图的方法,从七个司法管辖区中提取了有关护士ERPO请愿的信息。有护士作为申请人的ERPO法律是在1999年至2023年间通过的。护士申请人包括高级执业注册护士(3 人)、临床专科护士(3 人)、执业护士(3 人)、专业护士(2 人)和注册护士(1 人)。精神科/心理健康(n = 2)和学校护士(n = 2)均有具体说明。在处理作为《紧急恢复医疗保险条例》申请的一部分而披露的健康信息,以及法院如何处理健康信 息(例如,法院封存、法院保密、归还给医疗服务提供者/听证后/命令后处理)方面,法规各不相同。有三个州的法规规定,如果申请是善意提交的,申请者可以免除民事和/或刑事责任。其中两个州将免责范围扩大到了所有申请人,而一个州只提及了作为医疗服务提供者的申请人。研究结果具有重要的政策、临床和研究意义。
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引用次数: 0
Factors Influencing Hospitalization of Nursing Home Residents in Korea Using Regularized Negative Binomial Regression. 利用正则化负二叉回归分析韩国养老院住院患者住院的影响因素。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2024-06-14 DOI: 10.1177/15271544241259427
Juh H Shin, Sun O Jung, Eun J Min

The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses' increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.

疗养院(NH)居民住院治疗是否合适仍有争议,决定因素包括及时性、可用治疗、医护人员、医院用药选择以及安全问题。尽管导致住院的因素已被广泛研究,但有关人员配备的研究却十分有限。因此,本研究旨在调查韩国 NH 居民因感染或疾病住院的组织预测因素、护士人员配备和政府激励机制,并找出重要因素。研究采用横断面设计,通过调查收集了 2021 年 8 月 27 日至 2022 年 3 月 25 日期间 51 家 NH 的数据。共包含 32 个解释变量。响应变量是因感染或疾病而住院的居民人数。我们采用最小绝对缩减法和负二项回归法对数据进行了分析。我们发现,注册护士每住院日工作时间的增加与因感染或疾病住院人数的减少有关。应适当保留和招聘具有专业领导能力的护士人员,以提高对 NH 居民的护理质量。
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引用次数: 0
The Impact of the COVID-19 Pandemic on Staffing Levels in Philadelphia Nursing Homes: Disparities Based on the Racial Composition of Geographical Areas. COVID-19 大流行对费城养老院人员配备水平的影响:基于地理区域种族构成的差异。
IF 2.1 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2024-08-16 DOI: 10.1177/15271544241270061
Junyan Tian, Alyssa A Gamaldo, Kamesh Madduri, Carlos Tavares, Noble Maseru, David Saunders, Gary King

Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.

通过研究来评估卫生政策并为其提供信息,是决策过程中促进公共卫生实践公平的重要组成部分。本研究调查了宾夕法尼亚州费城老年人机构在 COVID-19 大流行期间(2020-2022 年)的健康差异,为政策倡议、干预措施和基础设施发展提供信息。我们首先探讨了 COVID-19 前后护理人员配置水平(直接护理人员总数和注册护士 [RNs])的变化模式,以每位居民每天的工作时间(HPRD)来衡量。我们的研究结果表明,从 2018 年到 2022 年,HPRD 水平一直低于美国医疗保险和医疗补助服务中心(Centers for Medicare and Medicaid Services)建议的标准,从 2021 年开始出现明显下降。多层次建模的结果显示,在黑人居民比例较高(≥40%)的邮政编码所在的养老院中,直接护理人员总数的 HPRD 显著下降。与此相反,在黑人居民比例较低的邮政编码(≥40%)的养老院中,护士的 HPRD 显著下降。
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引用次数: 0
Turnover Rates and Factors Associated With Turnover: A Longitudinal Analysis of the Retention Period of Clinical Nurses in Korea Using National Data. 离职率及其相关因素:利用全国数据对韩国临床护士的保留期进行纵向分析。
IF 1.8 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-05-01 Epub Date: 2024-02-28 DOI: 10.1177/15271544241231285
Yunmi Kim, Hyun-Young Kim

Many countries, including Korea, are struggling with a nursing workforce shortage. This study aimed to identify the actual turnover rate of Korean clinical nurses and the factors affecting the turnover rate, considering the time required for nurses to gain experience at their current medical institution. This longitudinal study followed up on a cohort consisting of all 107,682 nurses from January 1, 2017 to July 30, 2020. Differences in the distribution of retention and turnover according to the medical institutions' and nurses' characteristics were analyzed using the chi-square test. The hazard ratios (HRs) for turnover in each analysis interval were analyzed using multilevel Cox proportional-hazards analysis. The mean turnover rate was 10.0% within 1 year and 33.4% within 3.5 years. Several organizational characteristics (the type and ownership of the hospital, its location, and the bed-to-nurse ratio) and individual characteristics (gender, age, and clinical experience) were found to be associated with turnover risk. Among these factors, compared to hospitals with a bed-to-nurse ratio in general wards of 6.0 or more, those with a ratio of 3.5-3.9 had an HR for 1-year turnover of 0.81 (95% confidence interval [CI]  =  0.67-0.98), and those with a ratio of 2.5-2.9 had an HR for 3.5-year turnover of 0.77 (95% CI  =  0.66-0.90). The bed-to-nurse ratio is a condition that can be modified through collaboration between government policy-makers and medical institutions. To reduce nurse turnover and retain experienced nurses, appropriate staffing should be implemented.

包括韩国在内的许多国家都在努力解决护理人员短缺的问题。本研究旨在确定韩国临床护士的实际离职率以及影响离职率的因素,同时考虑到护士在当前医疗机构积累经验所需的时间。这项纵向研究从 2017 年 1 月 1 日到 2020 年 7 月 30 日对由全部 107682 名护士组成的队列进行了跟踪调查。根据医疗机构和护士的特点,采用卡方检验分析了留职和离职分布的差异。采用多层次考克斯比例危害分析法分析了每个分析区间的离职危害比(HRs)。1 年内的平均离职率为 10.0%,3.5 年内的平均离职率为 33.4%。研究发现,一些组织特征(医院类型和所有权、医院位置和床位与护士比例)和个人特征(性别、年龄和临床经验)与离职风险有关。在这些因素中,与普通病房床位与护士比为 6.0 或以上的医院相比,床位与护士比为 3.5-3.9 的医院 1 年的人员流动率为 0.81(95% 置信区间 [CI] = 0.67-0.98),而床位与护士比为 2.5-2.9 的医院 3.5 年的人员流动率为 0.77(95% 置信区间 = 0.66-0.90)。床位与护士的比例是一个可以通过政府决策者和医疗机构之间的合作来改变的条件。为降低护士流失率并留住经验丰富的护士,应实施适当的人员配置。
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引用次数: 0
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