實施專科護理師成效之探討

The Study of the Effectiveness of Setting Clinical Nurse Specialists in the Hospital

護理人員能力進階制度由衛生署推行至今已十年，醫院培訓的人員已足以擔任專科護理師之職務，唯於人力有效運用原則下，已設置以病房為基礎具備病患照護、醫療服務及護理專業等多方面能力的專科護理師。本文旨在探討提供專科護理師服務半年後，專科護理師制度之整體滿意度及醫院行政方面應做之配合。結果是病患或家屬、醫師、護理人員及專科護理師本身對專科護理師制度之整體滿意度高，且醫師及護理人員均分別表示對醫療業務及護理專業之提升助益甚大，顯示此制度有繼續推展之需要；專科護理師之角色功能未來應加強在提供飲食、用藥、起居等衛教之服務、能參與臨床路徑之製作、加強個案管理與出院計畫、追蹤出院病患復健狀況等項目；對各科醫療損益情況很難看出專科護理師之影響；待專科護理師制度之實施有法源依據後，則應幫助現正執業之專科護理師取得證書。

In implementing the nurses clinical ladder for about the past ten years, we have trained lots of competent nurses. One of the best ways in utilizing manpower , is to create a multiple-function nursing position（clinical nurse specialist） that combines the roles of clinical nurse specialist, case manager, discharge planner, nursing researcher, and coordinator. The purpose of this article is to evaluate the effectiveness of setting a multiple-function nursing position（clinical nurse specialist） in the hospital. Over ten surgical system wards have set ward-based CNS, after practicing six month and two years, from patients or family, physicians, nurses, CNS and hospital financial aspect to collect data, analysis and results are patients or family, physicians, nurses and CNS supported to set ward-based CNS ; to improve the CNS competence in health education include nutrition, medicine and life style changing, to participate in creating clinical pathways, to be a case manager and discharge planner. The CNS's performance can't be understood from the hospital's financial report, and we hope that the administration will help the CNS to get their licenses.