運用技術混合照護模式於護理工作負荷之探討

Exploring the Impact of Skill Mix Model on Nursing Workload and Intention to Stay

研究目的：本研究是探討技術混合照護模式實施後，護理人員自覺其工作負荷、留任意願及加班時數、離職率之影響。研究方法：為回溯性研究設計，以次級資料分析法，於照護模式施行後4、8、16個月進行3階段資料收集。研究對象為北台灣區域教學醫院選取6個病房（3個有施行，3個無施行），比較有無施行病房之護理人員自覺降低工作負荷程度、留任意願、加班時數及離職率之結果。研究結果：輔助人員執行及耗時最多的工作項目以『一般性技術工作』佔最多，有施行技術混合照護模式的病房其加班時數及離職率，較無施行的病房有逐漸下降的趨勢。利用ANOVA檢測4、8、16個月的執行結果：一、自覺降低工作負荷在介入後8、16個月開始有顯著差異（8個月VS.4個月：P<.00；16個月VS.4個月：P<.00）。二、加班時數初期成效不明顯，但8個月開始到16個月皆有顯著差異（0個月VS.8個月：P<.01；0個月VS.16個月：P<.01）。三、離職率及留任意願則無顯著成效。結論：依據評鑑護病比基準配置三班的護理人員再加入輔助人員的混合照護模式，確實能降低護理人員的直接負荷，但此模式需長期推動才能看出護理留任及回流的成效，未來建議可納入推廣老化社會之醫療照護激增的轉型參考。 Objective: The purpose of this study is to explore the change of nurses’ perception of workload, willing ofintention to stay, overtime and quit rate after implementing the skill-mixed model.Method: This is a retrospective study. The secondary data analysis was collected after implementing theskill-mixed model for four, eight, and sixteen months. Total six acute wards three of those implementedthis model but others didn’t were enrolled from regional teaching hospital in North Taiwan. The change ofnurses’ perception of workload, willing of intention to stay, overtime and quit rate was compared betweenwards with or without implementing the skill-mixed model.Result: Our results demonstrated that the duties of the unlicensed assistants mostly belonged to “generalbasic work”. The amount of overtime and proportion of quit both declined after implementing the skillmixedmodel. The results collected from four, eight, or sixteen months after the model implementationwere further analyzed by ANOVA. The results revealed that the overload perception declined significantlyafter eight and sixteen months skill-mixed model implementation as compared to that after four monthsimplementation. (8 months vs. 4 months: P < .001; 16 months vs. 4 months: P < .001); 2. The overtimedecreased significantly after 8 and 16 months implementation as compared to that before implementation.(0 month vs. 8 moths: P < .01; 0 months vs. 16 months: P < .01 ); 3. The willing of intention to stay andquit rate did not change significantly.Conclusion: Our results demonstrated that the proper patient–nurse ratio as designated by the hospitalaccreditation, adding the unlicensed assistants, could effectively attenuated not only the direct loading ofnurses, but also the caring burdens of patients’ family. The effect of this model on nursing intention to stayand return to workplace needed long term implementation. Therefore, our study suggested that the skillmixedmodel could be used to help further Taiwan’s healthcare delivery system transformation.