臺灣專科護理師工作項目及時間分配之探討

Nurse Practitioners’ Work items and its Time Allocation in Taiwan

背景：專科護理師（Nurse practitioner ,NP）是進階護理角色的延伸，此制度在臺灣推行已近30年，多數相關研究聚焦在角色能力上，但NP常執行的工作項目和時間分配為何，卻鮮少人探討。
目的：本研究旨在探討NP的工作項目與時間分配，特別是在醫學及非醫學中心服務的NP，其工作項目與時間分配有無不同，尤其是在指示性與自主性工作項目的比較。
方法：本研究合併三個NP資料庫，運用二次資料分析（secondary data analysis）方法。測量工具為NP工作項目與時間分配量表，共30題。414位納入分析的研究對象中，醫學中心有209位（49.8%），其服務單位以內科為主165位（39.9%）。
結果：研究發現醫學及非醫學中心之NP在30個工作項目中，有8個項目出現顯著差異：身體評估、身體照顧、執行口頭醫囑、書寫病程進展、監控整個治療品質與進度、參與個案討論會議、改善照護品質及各類課程發展的擬定之執行等，醫學中心NP的執行百分比都比非醫學中心NP高。在花費時間的比較上，30個項目中只有2個達到統計上的顯著差異，分別為指導護生與開立實驗室檢查單張，服務於非醫學中心的NP所花費的時間比服務於醫學中心的NP多。若把NP的工作區分為自主性與指示性兩大類，發現醫學中心與非醫學中心的NP在兩類工作上，無論在工作項目的執行或是平均時間的花費上皆無統計顯著差異。
結論：了解NP的工作項目和時間分配有助於醫療機構和專科護理師學會制定NP執業範疇，進而調整NP合理的工作量，達到減量增質的目的，對NP制度未來發展有正向助益。

Background: A Nurse Practitioner (NP) is considered as the extended role of the advanced practice nurse, and the system of NP has been implemented in Taiwan for nearly thirty years. Although most studies focus on the NP’s role and functions, few are on the work items and time allocation of the NP.
Purpose: The main purpose of this study was to understand the work items and time allocation of the NPs in the medical and non-medical centers in Taiwan, and to compare the differences of work items and time allocation between them, especially for the comparison of designated and non-designated work items.
Methods: This study integrated three NP databases and used secondary data analysis. NP work items and time allocation questionnaire which included thirty items was used as the measurement tool for this study. The subjects included four hundred and fourteen NPs from different levels of hospitals. Most NPs work in medical centers (49.8%) and their units mainly are the department of internal medicine (39.9%).
Results: This study showed that eight work items, including physical assessment, physical care, implementing physician oral order, documenting progressive note, monitoring overall therapeutic quality & progress, participating case conference, improving care quality and developing various courses on percentage of implementing had statistical significant differences between NPs in medical and non-medical centers. The percentage of implementing these items was higher for NPs in medical centers. Moreover, two items, including instructing nursing students and applying laboratory tests on time allocation had statistical significant differences between NPs in medical and non-medical centers.More time was spent on these two items for NPs in non-medical centers. In terms of the designated and non-designated work items, there were no statistical significant differences on percentage of implementing or time spent between NPs in medical and non-medical enters.
Conclusions: To understand the work items and time allocation of NPs is able to help medical institutions and the Association of Nurse Practitioners to clarify the scope of practice of NPs. It also helps to adjust the reasonable workload of NPs and achieve better quality of NPs. Our findings will provide positive benefits to develop the NP system in the future.