臨床照護模式新思維

A Novel Thought on the Clinical Nursing Care Model

近年來，護士荒愈益嚴重，除引起大眾媒體廣泛的討論外，其對醫療照護品質及病人安全亦產生嚴重的負面影響。根據中華民國護理師護士公會2012年的調查，全國有二十三萬多人領有護理師執照，卻祇有十三萬多人實際執業，就業率僅五成九；新進護理人員三個月內的離職率是三成二，工作一年離職率高達五成八，護理執業環境出現嚴峻的考驗。國內為解決及扼止護士荒的蔓延，健保局今年將護理照護品質方案的經費由去年的新台幣10億元調高為20億元，衛生署也提出諸多的改革策略，包括工時、薪資福利、護病比與教育養成等。然而何種策略的導入，既能維護病人安全、確保病人的照護品質，又能兼顧成本效益，實為當務之急。針對此議題，由國外之文獻顯示，技術混合照護模式(skill mix care model)已成為護理模式的主流，亦即在護理團隊中加入輔助人力，以緩解護理人員工作負荷及減少護理人員流失等問題，成為全球醫院管理的趨勢。護理主管的思維隨著醫療環境改變應有所變革，對於建構本土化技術混合照護模式，必然會面臨挑戰，希望藉由本文的文獻查證與具體可行之建議，可協助護理主管營造自己醫院護理照護模式新架構，打破以往純護理人員參與的照護模式，讓『資深護理人員不要走，新進護理人員留下來』，終結護士荒的窘境。

In recent years, the issue of nursing shortage has becomes so serious that there has not only been discussion in the mass media but also negative impacts on patient safety and quality of patient care. According to a survey conducted by Taiwan Nurses Association in 2012, more than 230,000 nurses were licensed, but only 130,000 nurses actually practiced. The employment rate was only 59%. The resignation rate of new nurses was 32% within the first three months of hiring, and up to 58% in the first year. Modification of the current healthcare environment for nursing practice is a huge challenge. To solve and stop the increase in nursing shortages, Bureau of National Health Insurance in Taiwan has increased the funds for enhancing quality of nursing care from one billion New Taiwan dollars last year to two billion this year. Department of Health in Taiwan has also proposed a lot of health reform strategies in working hours, salary welfare, nurse-patient ratio, and education development. Department of Health in Taiwan has adopted many strategies in the aspects of working hours, salaries and compensations, nurse-to-patient ratio, and nursing education, etc. However, it is imperative to find proper strategies in maintaining patient safety, ensuring quality of patient care, and watching cost effectiveness.Among those nursing care models used in domestic and foreign countries, a skill-mixed nursing care model has become main stream in clinical nursing practices. That is, adopting supplementary staff in a healthcare team may relieve the nursing staffs workload minimize the issue of nursing shortage. This has become a trend in global hospital management. The thoughts of nursing administrators should advance as the health care environment changes. They must face these challenges while establishing a new mixed-care model for nursing practices in Taiwan Through literature review with feasible recommendations, nurse managers may create a new framework of nursing care model for their hospitals. In this way, a new nursing care model may replace the old one to achieve the goal of retaining both senior nurses and brand new nurses, and resolve the dilemma of nursing shortage.