台灣醫療工會爭取三班護病比入法之歷史回顧

A Historical Account of Medical Union Efforts to Mandate Shift-Based Nurse-to-Patient Ratios in Taiwan

「護病比」對於提升照護品質的重要性不言而喻，早在2014年，我國政府就將「護病比」訂為施政目標，2019年「全日平均護病比」入法，立下重要里程碑，然而「全日平均護病比」僅規範「三個班別平均、全醫院平均、全月份平均」之後，每位護理師所照護病人的數量上限。由於平均後實際照護病人的數量遭到稀釋、失真，未能有效保障護理師不過勞，各護理團體數年來紛紛要求盡速研擬「三班護病比」，區分「白班、小夜、大夜」三個班別中，每位護理師照護病人數量的上限。2024年，歷經疫情的壓力與疫情後護理離職潮的衝擊，我國政府公告了「三班護病比」政策，然而新政仍採「平均計算」的邏輯，且僅對達標者提供獎勵、未針對超標者給予處罰，因此護理過勞問題，仍未有效改善。本文旨在說明醫療工會與護理團體爭取「三班護病比入法」的歷程，並分析工會如何在不同的倡議階段，使用調查、遊說、抗議等手段，督促政府推進政策，改善護理執業環境。

Achieving optimal nurse-to-patient ratios, widely recognized as critical to improving care quality, has been a key stated goal of national healthcare policy in Taiwan since 2014. Although the“daily average nurse-to-patient ratio”was codified into law in 2019, this regulation only defined the maximum number of patients per nurse based on an average across all three shifts, hospital-wide, and over a one-month period. This averaging approach dilutes and distorts the actual workload of nurses and fails to adequately protect them from overwork. In response, nursing associations have for years called for the implementation of“three-shift nurse-to-patient ratios”that set specific workload caps for day, evening, and night shifts, respectively. In 2024, following the strain of the COVID-19 pandemic and subsequent wave of post-pandemic nurse resignations, the government announced a new policy addressing three-shift ratios. Nevertheless, the policy maintains the averaging method and, while providing incentives to institutions that achieve targeted levels, does not impose penalties on those that exceed threshold numbers. Thus, this new policy does not resolve the fundamental issues behind the nurse overwork problem in Taiwan. This article was written to delineate the efforts made by labor unions and nursing organizations to enshrine three-shift nurse-to-patient ratios into law. In addition, the use by unions of tools such as surveys, lobbying, and protest actions across the different phases of advocacy to pressure the government, push policy forward, and improve the working conditions for nurses is analyzed.