台灣護理人力面面觀

Multi-aspects of Nursing Manpower in Taiwan

全民健保讓臺灣醫療保險普及化，服務量不斷的增加，但人口老化及慢性病盛行，病人的疾病嚴重度也增加，臨床照護工作更趨複雜。但健保總額預算制度實施後，醫院為了降低成本而精簡護理人力，讓護理人員的照顧負荷不斷的增加；且臨床專業與非專業的工作內容沒有區分，護理人員的專業角色功能無法發揮。長期人力短缺連帶也影響新進護理人員的留任率，與畢業生的就業意願。年輕人不願意投入臨床護理工作，我們的執業率只有6成（59.2%）左右，其累積的工作年資也只有7.67年，與歐美國家比相對低很多。不但阻礙臨床專業發展與經驗的傳承，對於醫療品質的確保也是一大隱憂。因此，現階段護理人力政策與護理人力資源管理的重點工作，除了採用獎勵留任措施降低離職率，改善臨床執業環境，降低每班每位護理人員照護病人數，可有效減輕臨床護理人員的工作負荷，讓領有護理證照但不執業的人願意回流，現職人力穩定，畢業生的就業意願將可提高。

National Health Insurance (NHI) program offered a comprehensive and universal health insurance program to all citizens in Taiwan. However, clinical care loading become complicated under the situation of increased service coverage, aging population, prevail of chronic disease, and number of critical patients. After 'the Global Budget System' was introduced by the Bureau of National Health Insurance (BNHI)to modify the funding mechanism, nurse work loading were continuing raised due to decreasing manpower for cost-benefit purpose by hospital. Simultaneously, there was no distinction between clinical specialty and non-specialty work, therefore, the role function of nursing cannot be exerting. Problems on the long-term shortage of manpower influence retention rate of recently employed personnel, and also affect desire of graduates who are going to work at hospital. There were only 59.2% registered nurses among all licensed nurses and 7.67 years of seniority working periodin Taiwan, which was lower than Western countries. This phenomenon obstructed our clinical professional development and working experienceinheritance, also it would be difficult to ensure the quality of healthcare provision. Consequently, the most essential work for Nursing Administration on the policy of nursing manpower and resources management at this stage will be implementing retention policy in order to reducingturnover rate, improving clinical working environment, and decreasing high nurse-patient ratio. Hence, lighten work load of clinical nurse effectively, stabilized current personnel, promoted licensed nurse return, and increased willingness of employment from those graduates will be accomplished.