三班護病比政策對各層級醫院護理人力的影響與對策──觀察型研究

The Impact of Taiwan’s Three-Shift Nurse-to-Patient Ratio Policy on Nursing Manpower in Hospitals at all Levels and Corresponding Countermeasures: An Observational Study

背景：為建立合理的三班護病比，衛生福利部於2024年3月1日起正式推動實施三班護病比標準。此對各層級醫院護理人力帶來的影響，值得探討。
目的：探討（1）三班護病比政策實施對各級層醫院護理執業現場與人力缺口的影響；（2）護理主管與護理師對此政策實施的看法。
方法：採描述性研究設計，招募三層級醫院的護理主管及護理師參與研究，以線上問卷進行資料收集。
結果：共分析了207名護理主管與680名護理師之資料，受訪醫院之實際開床數佔核定床位數的平均值為84.7%（SD = 18.5）。一到三季護理人力平均空缺率：12.1%、12.3%、11.7%；區域醫院明顯高於另兩級醫院。各院實際護理人力佔三班護病比所需人力比率的平均值為86.8%（SD = 22.4）。各班之照顧病人數，均明顯高於三班護病比規範。調整薪資、友善職場、留任獎金、三班津貼、缺額津貼與保障休假天數為達標三班護病比之主要助力。
結論／實務應用：政策的成功實施，需考量各級醫院的需求，並透過強化資源配置、提升政策彈性、優化人力調度與建立動態監測機制，使其更具適應性與可行性。

Background: To establish a reasonable nurse-to-patient ratio across the daily three-shift nursing work schedule, the Ministry of Health and Welfare implemented nurse-to-patient ratio standards for all three shifts on March 1, 2024. The impact of this new standard on the nursing workforce at all three hospital levels warrants further investigation.
Purpose: This study was designed to explore: 1. The impact of the implementation of this policy on the nursing manpower shortage in hospitals at each level; 2. The views of nursing supervisors and nursing staff on policy implementation.
Methods: A descriptive research design was employed and nursing supervisors and nursing staff were recruited from hospitals at all levels. All data were collected using an online questionnaire.
Results: Data from 207 nursing supervisors and 680 nursing staff were analyzed. The number of beds actually open in hospitals accounted for 84.7% (SD = 18.5) of the approved number. The average nursing vacancy rates in the first, second, and third quarter were 12.1%, 12.3%, and 11.7%, respectively. The average vacancy rate for nursing staff in regional hospitals was found to be significantly higher than those for the other two hospital levels. The actual average nursing manpower level was 86.8% (SD = 22.4) of t he m inimum level r equired t o s upport t he t hree-shift nurse-to-patient ratio. The average number of patients cared for by nursing staff in all three shifts was found to be significantly higher than the standard-defined nurse-to-patient ratio for these shifts. Nursing supervisors and staff members both agreed that salary adjustments, a friendly work environment, retention bonuses, third-shift allowances, vacancy allowances, and guaranteed vacation days were the primary factors affecting the achievement of the new three-shift nurse-to-patient ratio standard.
Conclusions/ Implications for Practice: The successful implementation of this policy requires taking into account the needs of hospitals of all levels, strengthening resource allocation, improving policy flexibility, optimizing human resource scheduling, and establishing a dynamic monitoring mechanism to ensure effective standards implementation and policy feasibility.