降低肝膽腸胃內科急性病房白班護理人員延遲下班率之專案

A Proposal to Reduce Nurse Overtime in Acute Medical Ward of Gastroenterology and Hepatobiliary Department

國內外臨床護理人員延遲下班情形嚴重，調查發現國內外延遲下班率約68-72%，長期累積勞累造成疲勞體力透支影響生活品質，甚至威脅到病患健康安全及醫療疏失等嚴重後果。本病房每日常有護理人員延遲下班的情形，造成身心疲憊想離職，及照護品質不佳等問題，故引發此專案動機。調查發現單位白班護理人員延遲下班率與院內其它內科病房及文獻比較後明顯偏高，確立問題後成立專案小組，目的在降低白班護理人員延遲下班率。透過運用人力分工、解決非專業性工作繁重、交班內容和書寫記錄簡化與資訊化、工作職責與切點重新分配等辦法。專案實行後，白班護理人員延遲下班總人次由217人降至112人，延遲下班率由77.8%降40.1%，不僅縮短延遲下班時間，減輕同仁身心疲憊與負擔，可提供類似問題改善之參考。

Working conditions that require nursing overtime is a serious issue. Investigation indicates that percentage of overtime worked by clinical nurses, domestic and abroad, ranges from 68% to 72%. A long-term accumulation of overtime results in chronic fatigue that could affect quality of life. It also contributes to the occurrence of medical negligence causing adverse events, which compromises patient health and safety. The acute care nurse of our ward frequently worked overtime, which had led to physical and psychological exhaustion that resulted in inattentiveness and poor quality of care. This motivated the execution of this project. To reduce the overtime of day-shift nurses, a task team was assembled, and the following interventions were implemented: utilization of division of labor, reduction of non-professional task burden, simplification and informationization of shift reports and documents, and reallocation of responsibility and cut-off point. After implementing these administrative protocols, the total number of day-shift nurses working overtime decreased from 217 to 112, and the percentage of overtime decreased from 77.8% to 40.1%. The overtime hours, as well as the physical and psychological fatigue of our staff, had been effectively reduced. This study can contribute to evidence-based improvement of similar issues.