降低外科病房護理師工作負荷──以一家台灣醫學中心為例

Reducing the Workload of Surgical Ward Nurses: A Case Study of A Medical Center in Taiwan

新冠疫情下外科病房護理師工作持續攀升，因此設立此專案目的為降低外科護理師工作負荷。團隊透過護理師工作負荷問卷和現場調查分析，確認問題為：大刀術後照護或照護者人力安排問題、非直接專業護理類工作負荷和快速出入院問題、跨團隊問題之處方和病情變化等七大高於3.5分之負荷點。透過重新分析大刀照護人力增編五人和精準排班；簡化之36項護理資訊記錄巨集導入和27項衛教工具建置；團隊協調處方和病情變化合作三大措施群組後，護理師工作負荷問卷七大項目，負荷分數均可被降低0.83到0.45分之間，且2022-2023年間病人安全指標含:跌倒傷害率0.024%-0.016%、管路事件通報20-10件、壓傷發生率0.028%-0.023%均為改善，也維持外科組人力滿編和離職率8.65%-8.67%穩定數據，顯示快速針對負荷點之介入可改善護理師負荷度和增加病人安全。

The workload of surgical ward nurses has increased following the COVID-19 pandemic. The present study examined the factors contributing to the workload of surgical nurses at a medical center in Taiwan. A workload questionnaire was administered to participating nurses, and seven items were identified as contributing to high workloads (>3.5 points). These items included postoperative care or caregiver arrangement challenges, nonnursing tasks, rapid hospital admission requirements, and monitoring prescriptions or changes in patient conditions. The following procedures were implemented to reduce workload on the basis of the findings: (i) flexible scheduling based on the scheduling of primary surgeries and the addition of five staff members, (ii) the use of electronic checklists of 36 nursing and 27 health education assistance items, and (iii) increased coordination of physician and nurse work tasks and rescue drill tasks. The results of a postintervention survey revealed that the scores for the seven aforementioned items declined from 0.83 to 0.45 points. Additionally, from 2022 to 2023, the quality indicators for fall injury rates, pipeline incident notifications, and pressure injury incidence improved from 0.024% to 0.016%, 20 to 10, and 0.028% to 0.023%, respectively. Furthermore, staff requirements were satisfied for the hospital’s 301 beds. Finally, the nurse turnover rate stabilized at 8.65%–8.67%. These results indicate that improving nurse workload can balance staffing requirements and patient safety.