| Objective(s):The retrospective analysis is based on the effects of nurses management work on nursing human resources,nursing quality,patient safety and career development under the vertical management in a third-class hospital of Yunnan Province.The advantages,effectiveness and existing problems in nurses management work under vertical management are discussed,and corresponding measures are proposed to provide reference for medical institutions at each level on how to utilize professional value of nurses and stabilize the nurse workforce.Methods:1.Retrospective StudyReview the data of the indicators such as nursing human resource management,nursing quality,patient safety,satisfaction,and nurse career development before and after the implementation of vertical management mode for the nurse position management in a third-class hospital in Yunnan Province from 2010 to 2021,observe the trend of changes and analyze its operational status.2.Qualitative ResearchThrough the literature review,understand the current research status of nurse position management under vertical management mode at home and abroad,combine with the opinions of nursing management experts in the hospital to formulate interview outlines.Using the purposive sampling method,21 nursing managers and 20 nursing backbones from a tertiary hospital in Yunnan Province were selected for semi-structured interviews.Using the phenomenological research method and assisted by Nvivo12.0 software,Colaizzi’s data analysis method was used to sort and analyze the interview materials,extract themes,and find out the advantages and problems in the operation of nurse position management under vertical management mode,and propose countermeasures.Results:1.Retrospective Study1.1 Nursing Human Resource ManagementFrom 2010 to 2011,the proportion of undergraduate degree holders was 19.57%to 21.10%.After the implementation of the vertical management mode for nurse job management in 2012,the proportion of undergraduate degree holders increased to 73.63%in 2021.Among them,75%of undergraduate degree nurses have improved their education through adult education under the incentive measures such as vertical performance distribution and nurse job management.The proportion of master’s degree or above holders increased from 0.83%to 1.06%,and the trend was significant(P<0.05).From 2010 to 2011,there were 0-50 dynamic adjustments in nursing human resources.After the implementation of the vertical management mode for nurse job management,nursing human resources were dynamically adjusted in a timely and regular manner.From 2012 to 2021,there were 56-353 dynamic adjustments of nursing human resources and 573-2857 days of inter-departmental support,saving 2-12 nursing human resources per year.1.2 Nurse Career DevelopmentFrom 2010 to 2011,the nurse turnover rate was between 0.07%to 1.52%.After the implementation of vertical management of nursing positions,it rose to 2.47%in 2014,and then slightly declined.In 2020,it was 0.21%and in 2021,it was 1.31%,with no significant trend change(P>0.05).From 2016 to 2021,the scores of nurse practice environment evaluation showed an upward trend with a significant change(P<0.05)and were higher than the average level of the province and the country.1.3 Nursing Quality1.3.1 Nursing Quality IndicatorsBefore the implementation of vertical management mode for nurse position management work(2010-2011),the qualified rate for critical care patients fluctuated between 97.15%and 100%.After implementation(2013-2021),it fluctuated between 86.48%and 99.79%,with no significant change in trend(P>0.05);before implementation,the qualified rate for nursing documentation writing fluctuated between 97.08%and 100%,and after implementation,it fluctuated between 64.79%and 98.77%,with no significant change in trend(P>0.05);before implementation,the compliance rate for health education fluctuated between 72.13%and 96.23%,and after implementation,it fluctuated between 81.43%and 99.35%,showing an overall upward trend with a significant change in trend(P<0.05);the qualified rates for high-alert drug use and the implementation of regulations and rules have shown an upward trend since being included in monitoring,with a significant change in trend(both P<0.05);the qualified rates for adverse event management,fall prevention management,and correct execution of doctor’s orders have slightly increased after being included in monitoring,with no significant change in trend(all P>0.05);the correct identification rate of patient identity has fluctuated between 95.93%and 97.62%since being included in monitoring(comparison of 2017 and 2018,2018 and 2019 all P>0.05,others all P<0.05),and decreased by 1.69%in 2021 compared to 2016(P<0.001);the qualified rate for pain management has shown an upward trend since being included in monitoring(comparison of 2016 and 2017,2017 and 2018 all P>0.05,others all P<0.05),and decreased by 0.25%in 2021 compared to 2020(P<0.001);the qualified rate for blood transfusion treatment management has shown an upward trend since being included in monitoring(comparison of 2018 and 2019 P>0.05,others all P<0.05),and increased by 0.69%in 2021 compared to 2016(P<0.001).1.3.2 Quality Indicators for Specialized Medical CareFrom 2017 to 2019,the incidence of bleeding and swelling at the puncture site after coronary intervention surgery decreased annually(P<0.05),and the incidence of subcutaneous bleeding at the injection site of low molecular weight heparin decreased by 0.21%in 2019 compared to 2017(P<0.05).The qualified rate of semi-recumbent position for patients with artificial airways in the intensive care unit increased annually from 2017 to 2019(P>0.05 between 2017 and 2018,and P<0.001 for the rest),and the qualified rate of tracheal tube cuff pressure fluctuated between 95.97%and 99.81%(P>0.05 between 2017 and 2018,and P<0.001 for the rest),which increased by 2.81%in 2020 compared to 2017(P<0.001).The qualified rate of fixation of the urinary tract in urology tended to increase(P>0.05 between 2017 and 2018,and P<0.001 for the rest),and there was a statistically significant increase in the qualified rate of getting out of bed after surgery and the qualified rate of removing the catheter by Kegel exercise in the rehabilitation nursing of prostate hyperplasia(P<0.05).1.4 Patient Safety IndicatorsFrom 2011 to 2021,the incidence of falls remained at 0.01%,while the unplanned catheter removal rate fluctuated between 0.02%and 0.04%,with no significant trend(all P>0.05).The unplanned removal rate of gastrointestinal tubes,central venous catheters,tracheal intubation,and medication errors decreased significantly during this period(all P<0.05).1.5 Satisfaction Indicators1.5.1 Performance Evaluation of Inpatients Satisfaction in Third-class Public HospitalsFrom 2019 to 2021,the satisfaction survey results of inpatients’ assessments for the performance evaluation of the third-class public hospital of this institution fluctuated between 88.71%and 94.07%,and the trend of change was not significant(P>0.05).In 2018,2020,and 2021,the satisfaction rates were all higher than the average in Yunnan Province and the national average.In 2019,the satisfaction rate was higher than the average in Yunnan Province but lower than the national average.1.5.2 Satisfaction of Inpatient,Doctor,and NurseFrom 2013 to 2021,patient satisfaction in hospitalized patients showed an upward trend,and the changing trend was significant(P<0.001);From 2012 to 2021,doctor and nurse satisfaction showed an upward trend,and the changing trend was significant(P<0.05).2.Qualitative ResearchThis study used Nvivo 12.0 software to analyze and organize data,extracting eight thematic groups including experience,vertical management,job configuration,performance assessment,job promotion,layered training,job management,and career planning.The study focused on 27 thematic areas,including experience and identification,and identified 342 meaningful statements.Conclusion(s):Under the vertical management mode of a certain third-class hospital in Yunnan Province,the management of nurse positions is in good condition,which has improved the management efficiency of nursing,clarified the direction of career development for nurses,stabilized the nursing team,and increased the satisfaction of inpatients,doctors,and nurses with nursing work.However,continuous improvement is needed in areas such as promotion,assessment,job training,and management of specialist nurses.It is recommended to set promotion and assessment indicators for nurses based on their clinical abilities and level,fully consider the career development needs of senior nurses,and incorporate specialist and dispatched nurses into the management of nurse positions,while emphasizing information technology construction. |
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