| In western countries, there are rigid clinical paramedic classification systems called job descriptions in which the duties of nurses in different grades are ruled, which has provided a better base for the developing of the whole nursing mode. However, so far in China, there have been only the strict nurse qualification and admittance system and the nurse title review system, and there is no legislative authority to the nurse classification and the post distributing. It makes most domestic hospitals carry out the simply plat management, in which nurses in different education background, title and position have the same obligation, and the scientific management on nurse human resource cannot be realized. In this paper, a new concept grade specific ability is proposed. It is a scientific and feasible theoretical ability level system of nurses. We consult the current situation and the progress of the research of paramedic classification in western countries. In order to meet the requirement of Chinese title appraisal system and clinical nursing, we study the ability level system of clinical nurses in quantity and quality and set up this system by the means of Delphi. It is expected to provide the theoretical base for health government's policy and to offer a scientific method of cultivating and using nursing talents.Section A Survey on the state of different classes of positions of the clinical nurses relevant to their ability levels. Objective in order to find out the degree of how the clinical nurses in different classes of positions being matched with their ability levels. Method on the basis of document searching and integrating the view of senior experts, use the self-designed questionnaire of the correlative state of different classes of positions of the clinical nurses relevant to their ability levels on the work items, work proportion, work time, work stress and self-evaluation from 438 clinical nurses in different work seniority, degree and title. The questionnaire has reliability and validity because of analysis by Cronbach. Result a. All clinical nurses in different classes of positions are engaged in daily nursing, basic nursing, operating the treatment, serious patients'nursing, health education, clinical teaching, clinical research and management of nursing unit. b. The order arrangement of work proportion from high to low is basic nursing, operation treatment, daily nursing, health education, serious patients'nursing, management of nursing unit, clinical teaching and clinical research. c. All of the nurses who have the degrees of technical secondary school and junior collage and have the titles of nurse and nurse practitioner are engaged in all of different work time, and those who have the degrees of undergraduate and have the titles of attending nurse practitioner are basically engaged in management, and almost work at"work of 8 to 4","normal work","work of 10 to 6","work of 6 to 2", and the work time of those whose work senioritis are over 10 years trends to be simplified. d. the pressure in executing nursing independently: in the view of the nurses in different education backgrounds,titles,seniorities doing health education,nasal breeding and intensive care, the main reason of the expressure exsit is seniority,education background and title. e. The working enthusiasm of the clinical nurses in different classes of positions is: the highest is 11.8%, the higher is 50.5%, the normal is 36.2%, and the less high is 1.4%. The arrangement of the main factors in the nurses'working enthusiasm is: the lack of the definite career future, the lack of efficient inspiring mechanism, the lack of individually career designing for the nurses by organizations, other factors and the lack of the team sprite in the working circumstance. f. The degree of the nurses'competence is: 71.9% of the suitable, 11.9% of the slightly suitable and 16.2% of the unsuitable. g. The nurses'self-evaluations on the working efficiency: the higher is 60.3%, the normal is 31.7% and the highest is 8.0%. h. The judgment by the clinical nurses on the matching of their work item and work seniority: the absolutely matched is 9.8%, the relatively matched is 66.2%, the matched is 14.2%, the relatively unmatched is 3.2%, and the unmatched is 6.6%. Conclusion The degree of how the clinical nurses in different classes of positions being matched with their ability levels is related to the factors such as their work seniority, the difficulty of work item, working enthusiasm and career future. This paper suggests establishing the ability level system of clinical nurses, which clearly defines the nurses'position standards, responsibilities and tasks, and the clinical nurses in different classes of positions can engage in the work which is matched with their ability level, so that the security and validity of nursing can be promoted. The establishment of the ability level system of clinical nurses sets up the base of promoting the whole nursing. And this paper will be a scientific theoretical gist for the establishment of the system.Section B Quality Survey on the classification of the ability level system of clinical nurses. Objective in order to study the necessity and feasibility of the classification of the ability level system of clinical nurses in nursing practice. Method through purposive sampling and opening interview, specialists and groups talking to 5 senior charge nurses and 9 nurse in different age, education background, title on the obligation of the classification, the basis of the classification, the functions of nurse and the suggestions. Result a. The significance of classification: it will be good for the development of nursing, cultivating nurse talents, display of nursing value, improving the connotative value of nursing and promoting the degree of patients'satisfaction. b. The classification basis in order are the working ability, professional dedication, assessment by specialist group, the degree of patients'satisfaction and comment by colleagues, but the education background and seniority are not the main basis. c. After the nurses are given the different post according to their grade specific ability, the nursing management is more efficiently. d. Suggestion: The establishment of the system of ability level must accord with the relative health law; the distribution of the nursing post must match with the knowledge, skill, attitude, communication ability and harmony ability of the nurses in different grade; the authorities of nursing items must be definition scientifically; the admittance, examination and promotion of the nurses in different grade must be certificated by authority organization. Consult The classification of the ability level system of clinical nurses is necessary and feasible for nursing practice. And it gives the clinical nurses a clear development direction for their career design. It also give the resource guarantee to the promoting the security and effectiveness of nursing. This paper will offer a practical instruction to the establishment of the system of the ability level of clinical nurses.Section C Survey on the theoretical ability level system of clinical nurses. Objective On the basis of the scientifically predicting and analyzing of the grade of nurses, the study establishes a scientific and feasible ability level system of nurses. Method On the basis of relative document searching and the quality and quantity study to the ability level system of clinical nurses, we design the specialist mail questionnaire about the study of the theoretical ability level system of clinical nurses in 3-Grade A integrated military hospitals. In this questionnaire, there are 4 parts, classification framework, admittance standard, work duty and items and information of the specialist. In the way of specialist meeting and Delphi, we consult 24 specialist who are nursing executive administrators, technique administrators and education administrators in two 3-Grade A integrated military hospitals, one military special hospital and one military medical university. After twice consultation and the statistical analysis, the ability level system of clinical nurses is established, including classification framework, admittance standard, work duty and items. In th classification framework, the nurses are divided into four grades, those are grade I nursing staff and assistant nurse, grade II registered A nurse and registered B nurse, grade III professional nurse and grade IV nurse specialist. Admittance standard: The nursing staff is engaged in patients'daily care and nurse who is the eligible of specialty nurse staff training for six months after she finishes her secondary school; the assistant nurse is engaged in basic nurse who has the degree of the nurse technique secondary school and has the seniority shorter than one year or who hasn't got the certificate of nurse competence; the registered A nurse is mainly engaged in operating the treatment who has the certificate of nurse competence and has the seniority of 1 to 3 years; the registered B nurse is mainly engaged in serious patients'nursing who has the certificate of advanced nurse competence or who has the certificate of nurse competence and has the seniority over 4 years; professional nurse is mainly engaged in health education and clinical teaching who has the certificate of charging advanced nurse competence or who has the certificate of advanced nurse competence and has the seniority over 5 years; the nurse specialist is mainly engaged in clinical research and management of nursing unit who has the certificate of director nurse competence. The obligation of nurses in different classes: nursing staff has 5 entries, assistant nurse has 8, registered A nurse has 8, registered B has 7, professional nurse has 8 and nurse specialist has 9. The numbers of work items of nurses in different classes: nursing staff has 15 entries, assistant nurse has 21, registered A nurse has 41, registered B has 23, professional nurse has 12 and nurse specialist has 15. The result of the mail questionnaires is analyses statistically. The result can be believed.The result of this paper indicates that the establishment of the system of ability system of clinical nurses gives the clinical nurses a clear development direction for their career design, gives the resource guarantee to the promoting the security and effectiveness of nursing, offers a scientific method of cultivating and using nursing talents and provides the theoretical base for health government's policy. |
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