People have been sent to the hospital, so why have to hire a caregiver?
Experts suggest setting up assistant nurses to replace nurses to reduce the burden on patients
● With the rapid development and growth of the nursing staff group, problems such as low entry barriers, poor professionalism, arbitrary fees, and even patient abuse have been accompanied by problems, which have been criticized by the society
● The shortage of nurses is one of the important reasons for the emergence of nursing workers in our country.
After the reform and opening up, hospitals are in a stage of rapid development, and the bed-to-care ratio is seriously insufficient.
At present, in addition to the hospitals not paying enough attention to the nursing team and investing in nursing human resources, the supervision department also lacks rigid indicators for the assessment of the bed-to-care ratio standards of public hospitals, and does not form rigid constraints on the hospitals.
● Experts interviewed call for the use of the opportunity of medical reform to expand the nurse team, allocate sufficient strength, establish assistant nurse positions to take care of patients, and replace nursing workers, so as to enhance the professionalization and professionalization of nursing and further satisfy the needs People's demand for nursing services
□ Our reporter Chen Lei and Han Dandong
□ Trainee reporter Zhang Shoukun
"Looking at my grandma's arms are blue and purple, our whole family is very angry." On December 21, 2021, the grandmother of Beijing Min Xiaohua (pseudonym) strongly requested to be discharged from the hospital.
After arriving home, the old man told his family that he had been abused by the nursing staff in the hospital, so he refused to continue receiving treatment in the hospital.
Xiao Hua told a reporter from the Rule of Law Daily that her grandmother was sent to a third-class hospital in Beijing for emergency treatment on December 17.
After the first aid, the elderly stayed in the hospital for observation.
Originally, the family was not prepared to find a nursing worker, but the hospital did not allow family members to accompany it, saying that it was necessary for the prevention and control of the epidemic, and that the hospital had cooperative nursing workers who could provide escort services.
"The caregiver is fierce. He thinks I'm fat, so he tried very hard when he helped me turn over, and he hit me hard," said the old man.
Xiao Hua quickly took the video and photos, and negotiated with the hospital. The hospital said that after investigation, he would give an explanation.
On December 30, the hospital gave the phone number of the company to which the nursing worker belongs, and asked her to contact him directly.
"I didn't expect the nursing union to treat patients like this!" Xiao Hua said, "Why can't the hospital take care of the work of nursing workers, and why can't the nurses take it?"
This is not only the doubt in Xiao Hua's mind, but also the voice of many people.
It is understood that the group of nursing workers in my country first appeared in the early 1990s. The causes are complex, including the rapid economic and social development, the shortage of medical and nursing resources, and the inability to meet the needs of the people. There are also the fact that parents are sick and hospitalized, and many only children have no time to take care of the reality. The predicament and the market-oriented opportunity of the reform of the medical industry at that time led to the gradual formation of a "army of nursing workers".
With the rapid development and growth of the nursing work group, problems such as low entry barriers, poor professionalism, arbitrary fees, and even patient abuse have been accompanied by problems, which have been criticized by the society.
Recently, a number of patients, their families, experts and scholars interviewed by reporters called for the opportunity of medical reform to expand the number of nurses and staff, and to create assistant nurse positions to take care of patients and replace them with nursing workers to improve nursing care. The level of specialization and vocationalization further meets people’s demand for nursing services.
"The money the child makes is not enough to hire a caregiver"
Ms. Lin from Beijing, who is in her 30s, works in a public institution.
In recent years, she has had many experiences of hiring a caregiver, whether it's the birth of a child by herself or the hospitalization of a sick parent's family.
Although the existence of a caregiver solved her big problem, in her opinion, it is really helpless to hire a caregiver.
In 2017, Ms. Lin’s mother-in-law performed minimally invasive heart surgery, and the hospital required family members to accompany her. Considering that she and her husband have to go to work during the day and have to take care of the children, she really didn’t have the energy to accompany her, so she hired a professional app. The daily cost of a caregiver is 220 yuan.
In February 2021, Ms. Lin was hospitalized to give birth to a second child. Due to the needs of epidemic prevention and control, the hospital stipulated that family members could not enter the ward. The nursing fee is 300 yuan.
After 7 days of hospitalization, Ms. Lin paid more than 4,400 yuan for medical expenses and 2,100 yuan for nursing expenses.
She lost 800 ml of blood due to cesarean section, and Ms. Lin was very weak after giving birth.
The nurse is in the ward 24 hours a day, helping her to go to the toilet, changing diapers for the child, and assisting in breastfeeding. They are more dedicated.
During the conversation, Ms. Lin learned that the nurses staffed by the hospital are not hospital employees, but staff dispatched by a company that cooperates with the hospital.
"Isn't a nurse just a caregiver? Why don't the nurses do these tasks, but let the outside care workers do it? Doesn't this add an extra financial burden to the patient's family." Ms. Lin said that a care worker was in charge of a ward at that time and took care of 2 to 2 Three mothers and their babies, that is to say, the daily cost of nursing staff in a ward is 600 yuan or 900 yuan, "this money is enough to add one or two nurses."
During the interview, many people have had similar experiences with Ms. Lin and expressed the same views as Ms. Lin.
"The cost of nursing care is really a lot of money. If it weren't for our four siblings to share, the pressure would be too great." said Zhang Qiang (pseudonym), a 39-year-old Shanghai citizen.
He recalled that in early 2020, his mother was seriously ill and was hospitalized.
In the beginning, between relatives and carers, he and his three sisters chose the former, and everyone took turns to accompany them.
Later, when the new crown pneumonia outbreak broke out, the hospital strengthened the management of the ward, and the three sisters lived far away and it was inconvenient to go back and forth. The important task of accompanying his mother fell to Zhang Qiang alone.
For Zhang Qiang, taking care of his mother is part of his own business, but the combination of work, family, and escort makes him really "unbearable."
Later, the family negotiated and hired a care worker to accompany him 24 hours a day, with a daily fee of 300 yuan and 9,000 yuan a month.
The reporter consulted many housekeeping companies that provide nursing services in Beijing, Shanghai, Guangzhou, Chengdu and other places on the grounds that they needed to hire a nursing worker, and learned that the cost of one-to-one nursing is basically between 200 yuan and 300 yuan per day. Some patients with serious illnesses The cost of escort is higher.
In the summer of 2021, Wang Zhonghua (a pseudonym), a resident of Jizhou District, Tianjin City, was hospitalized in a tertiary Class-A hospital in Tianjin due to a heart attack.
Because his two sons were busy with work and heavy family burdens, Wang Zhonghua offered not to accompany their children.
But the two sons were worried that it would be inconvenient and accidental that no one would be accompanying their mother. After consulting, they hired a caregiver for their mother.
Hearing that the nursing fee is 240 yuan a day, and that it costs 2400 yuan to stay in the hospital for 10 days, Wang Zhonghua said distressedly: "It's too expensive, and the child's money is not enough to hire a caregiver."
If a family member is sick and hospitalized for one month, calculated at 240 yuan per day, the nursing fee alone will cost 7,200 yuan a month.
The reporter checked the information and found that the average monthly salary of employees in Tianjin in 2020 was 6,777 yuan, while in Jizhou District, Tianjin, many ordinary wage-earner family employees earned only 3,000 to 4,000 yuan per month.
In other words, in Tianjin, ordinary workers cannot afford nursing care fees based on their personal wages alone.
"200 yuan per day, 1400 yuan for 7 days, plus 200 yuan for meals, a total expenditure of 1600 yuan." Recently, Zheng Gang (a pseudonym), a citizen of Baoding, Hebei Province, settled an account after his mother recovered and was discharged from the hospital. His mother was hospitalized for 7 days. , Medical expenses will be paid more than 2,000 yuan after medical insurance reimbursement, and the cost of nursing work will reach more than 1,600 yuan.
Zheng Gang's mother is 89 years old and suffers from coronary heart disease, hypertension, diabetes and other diseases. Hospitalization is commonplace, and asking for a nursing worker has also become a normal choice.
"No way. The hospital told me that either family members should take care of the elderly or hire a caregiver. I have to take care of my daughter's daily life and take my grandson to and from school. Besides, at my age, I don't have the strength and energy to stay up late to take care of my mother." Zheng Gang said that for ordinary families like him, the cost of nursing care is undoubtedly a heavy burden.
In this regard, Ma Chaoyun (a pseudonym), a resident of Yongqiao District, Suzhou City, Anhui Province, also has a deep understanding.
In mid-October 2021, he accidentally fell while riding an electric bike and broke his leg bone.
When handling the hospitalization, the hospital clearly stated that the patient needs someone to accompany him during the hospitalization period. If the relatives cannot accompany him, he has to hire a nursing worker, and the nursing worker pays his own expenses.
According to someone’s introduction, Ma Chaoyun joined a WeChat group of nursing workers, and learned that the starting price for nursing workers is 240 yuan a day. According to the patient’s age and self-care ability, corresponding expenses need to be increased. In addition, he has to bear the daily food expenses of the nursing workers.
In the end, Ma Chaoyun hired a caregiver at a daily cost of 260 yuan, including 240 yuan for the care work and 20 yuan for food.
In the 17 days in the hospital, he spent a total of 4,420 yuan in nursing care costs.
"I earn less than 4,420 yuan a month." Ma Chaoyun told reporters. He didn't expect to spend such a large amount of hospitalization and nursing fees. Time to be hospitalized, even the nursing fee cannot be paid.
Indeed, for families with patients who need to be hospitalized for a long period of time, the burden of nursing care costs is particularly deep.
In the second half of 2020, the father of Beijing citizen Wang Shufen (pseudonym) was admitted to a tertiary hospital in Beijing due to bladder cancer and cerebral infarction, and hired a 24-hour nurse through the hospital. The nurse was responsible for the daily care of two patients in the ward. Each patient A monthly fee of 6,000 yuan is required for nursing care workers.
Wang Shufen's father died in June 2021 after living in the hospital for more than 10 months.
In the meantime, in addition to medical expenses, she has paid more than 60,000 yuan for nursing work.
"Every time I pay, I think, why do I need to hire additional nursing workers? After the patient is sent to the hospital, shouldn't the hospital take care of the nursing work?" Wang Shufen said.
"As long as you can take care of others, you can go to work"
What makes Wang Zhonghua particularly dissatisfied is: "After spending so much money, the service of the nursing staff is not good."
She told reporters that at the beginning, especially when her son was present, the caregiver was very patient and diligent, feeding herself, changing clothes, helping herself to the toilet, and the service was very thoughtful; however, within a few days, the caregiver started. Shows impatience, and often looks like he doesn't respond and doesn't feed anymore.
After making repeated requests, the nurse got bored and beat her twice.
This is not alone.
During the interview, many patients and their families complained to reporters about the professionalism and professional ethics of nurses.
When Su Xi (a pseudonym), a citizen of Beijing, was accompanying his mother in a tertiary hospital in Beijing some time ago, he repeatedly saw nurses eating patients' food without permission.
Once, the child of an old man in the ward brought fruits and nutrients.
As soon as the children left, the caregiver opened the packaging bag, leaned on the folding bed and ate for himself, not avoiding the patient and others at all.
What makes Su Xi even more unacceptable is that some nurses abuse patients.
On the hospital bed opposite Su Xi's mother lived an old man who had just amputation. After the pain of the anesthetic passed, the old man felt pain and cried.
When the nurse saw this, he immediately reprimanded: "Why cry? It won't hurt anyone after the operation. If you cry again, it doesn't matter to you." The old man hurriedly stopped crying.
Since then, the old man has been reprimanded by the caregiver many times.
All sorts of scenes made Su Xi firm in his determination to "no matter how hard and tired I am, I have to accompany my mother by myself, and resolutely not find a caregiver".
The patient yelled several times and ignored them, and found it troublesome to scold the patient whenever something happened. When feeding the patient who did not want to eat, he forcibly opened the patient’s mouth and stuffed it in with a spoon... Shaoyang, Hunan, who has been a nurse in Guangdong for many years Ms. Xie, who couldn't understand the actions of some colleagues, finally chose to change careers.
Of course, there may be only a small number of caregivers with bad attitudes and bad behaviors.
During the interview, many patients and their family members also said that the nurses they met were very responsible and rushed to do the dirty work, which gave the patients a lot of comfort and solved the family's worries.
Compared with this, the lack of nursing ability of nursing workers is a more common problem.
Song Jiaming (pseudonym), who has worked as a nurse in a tertiary hospital in Tianjin for more than 10 years, told reporters that many nurses lack professional nursing knowledge. Just turn over, which may cause the wound to rupture, and in serious cases, a second operation will be required.
“Nursers often come into contact with patients’ blood, secretions, excreta, etc., and are relatively easy to be infected by various pathogenic microorganisms. They are a high-risk group of infectious diseases. However, they generally lack understanding of nosocomial infections and their hazards, which increases the risk of nosocomial cross-infection. Risk." Song Jiaming said.
It is understood that the reason for the lack of nursing ability and poor professionalism of the nursing staff group has a lot to do with its low entry barriers and irregular training.
As a job seeker, the reporter walked into many housekeeping companies in Beijing and Tianjin, and dialed the online nursing staff recruitment phone to find out that the recruitment conditions for nursing staff were set very broadly, with no restrictions on education and no relevant experience. The age is best Forty or fifty years old, hard-working, quick and easy.
"Just bring your ID card and pay 300 yuan for the management fee. After signing the contract, you will be allocated a living. The monthly salary is guaranteed to be 3,000 yuan. If it is good, you can earn 6,000 to 7,000 yuan a month." The person in charge of a government company told reporters.
When the reporter raised the concern that he "has not received nursing training and I don't know whether he can be qualified for this job", the person in charge of the housekeeping company said immediately, "No training is required, as long as you can take care of someone, you can go straight to work."
The reporter randomly contacted and interviewed more than 10 nurses. Among them, 3 had never received any nursing training. Some of them were still working at the construction site yesterday, and they switched to working as nurses today.
A nurse told reporters that when her housekeeping company introduced a recently hired colleague, she said that she “had worked at XX Hospital last year and went to XX Hospital again this year, with very rich nursing experience”, but in fact This colleague had been raising children in his hometown before.
It is said that for nurses who have received training, many of the trainings are merely formalities.
Some nurses said that the housekeeping company gave them training before taking the job, and the training format was to watch video lectures by themselves; some nurses said that the housekeeping company issued a book about nursing for her to read, even if it was training.
Many people in the industry pointed out that nursing work seems simple, but serving special groups in special places actually requires high professionalism.
Take making a bed as an example. There are many precautions. For example, stop making the bed when a patient is eating in the ward; try not to make the middle order (puerperal mat, urine barrier) contact the patient’s skin; patients who are not awakened from anesthesia should lie on the pillow and lie down. Tilt the head to one side and stand the pillow horizontally on the head of the bed to prevent the patient from hitting the head due to restlessness.
"If there is no systematic and professional learning and training, there are great risks and hidden dangers in carrying out nursing work." Song Jiaming said frankly.
In addition, according to public reports, there are still a series of problems in the nursing work market, such as difficulty in refunding fees, difficulty in dispute resolution, and disorderly competition.
"Too tired, we are really too busy"
During the interview, many patients and their family members expressed the hope that nurses can take care of the patient’s life and reduce the burden of the patient’s hospitalization on the family; even if the extra cost of life care must be paid, they hope to give the money to In the hospital, life care is carried out by the staff of the hospital, which is more professional and more reassuring.
In fact, in accordance with the requirements of the "Notice on Strengthening Hospital Clinical Nursing Work" issued by the former Ministry of Health in 2010, nurses should fully perform their duties and complete clinical nursing work, including close observation, in accordance with the provisions of the "Nurse Regulations" and "Nurses Code". The patient’s vital signs and condition changes; correct treatment, medication and nursing measures, and observe and understand the patient’s response; provide life care and assistance to patients who cannot take care of themselves.
In reality, the reporter learned that, with the exception of some special wards such as infectious disease wards, where the patient's life care is undertaken by nurses, all patients in other wards who need life care are undertaken by relatives or nurses.
Some hospitals cooperate with third-party agencies to provide paid life care services; some hospitals do not have relevant cooperation, and family members have to find nursing workers themselves. The sources of nursing workers are nursing service companies, housekeeping companies, and independent nursing workers.
So, why can't nurses take care of inpatient life care services?
During the interview, the reporter heard the most: There are too few nurses.
"Too tired, we are really too busy." Song Jiaming said bluntly.
When I saw Song Jiaming on the afternoon of November 17, 2021, she had just woke up shortly after she was on a night shift.
"One night, I was busy and tired, and I felt very tired." Song Jiaming said that there were nearly 40 inpatients in her department that night, and there were only 2 nurses on duty. She was on the night shift to measure blood pressure, blood sugar, and infusions for patients. , Dispensing medicine, more than 2 hours after the round has passed.
"6 new patients were admitted that night, and they had to go through the reception procedure; some patients had just had an operation and needed to check their physical condition regularly; some patients suddenly felt uncomfortable in their heart, so they should promptly notify the doctor..." Song Jiaming said, busy all I'm too busy to take care of others.
There are 10 to 11 night shifts every month. Song Jiaming has been working at this pace for many years.
In fact, the whole department she works in is like this-the department has 53 beds and treats thousands of patients who need surgery every year, and there are only 12 nurses plus the head nurse.
According to the requirements of the national health authority, the bed-to-care ratio (the ratio of the number of beds in the hospital ward to the nurses in the ward) should not be less than 1:0.4. "In this way, there is a gap of more than 9 nurses in our department."
In this regard, Li Jing (pseudonym), who has also worked as a nurse for more than 10 years in a tertiary hospital in Beijing, also feels deeply.
She recalled that she used to work as a nurse in the ICU. There were many patients and few nurses. She often went to a large shift (24 hours) first, and could not go home directly after get off work. She had to rest in a dormitory specially vacated by the department. Hours, and then a small shift (8 hours) before I can go home from get off work.
"The number of nurses has not been increased for so many years. On the contrary, many nurses have been transferred from the front line of clinics or even resigned because of too heavy work." Li Jing said, and later she was transferred to another department of the hospital.
In sharp contrast to this, in the eyes of some patients and their families, nurses do nothing except infusion, medication, and temperature measurement.
Ms. Lin said that during her hospitalization, nurses were rarely seen in the ward. It seemed that apart from transfusion and temperature measurement, other things had nothing to do with it.
"Is it because the number of nurses is insufficient, or is it that nurses are simply unwilling to take care of patients?"
Several interviewed experts pointed out that the shortage of nurses is indeed one of the important reasons for the emergence of nursing workers in our country.
In the 1990s, due to the economic and social development of our country, the continuous improvement of people's living standards and needs, coupled with the increase of only children, the socialization of hospital logistics, the shortage of human resources and other comprehensive factors, the emergence of nursing workers and the gradual formation of a "army of nursing workers".
Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, said: “In the 1990s, with the development of social economy, medical care resources lagging behind service demand. At that time, the market-oriented reform of the medical industry also gave room for the development of nursing workers. "
"The emergence of nursing workers is closely related to the rapid development of my country's medical institutions. After the reform and opening up, hospitals are in a rapid development stage, and the bed-to-care ratio is seriously insufficient." said Li Ruonan, who works at Peking University Third Hospital.
According to public data, although the number of registered nurses in my country has been increasing in recent years, it has reached more than 4.7 million by the end of 2020, and the number of registered nurses per 1,000 population is nearly 3.4, but it still falls short of the standards of the European Union, the United States and Japan.
The basic standard for the number of registered nurses per 1,000 population set by the European Union is 8 or more, while the United States and Japan are 9.8 and 11.49 respectively.
Nurses in most countries in the world account for about 5‰ of the total population.
Earlier, media reports stated that there is still a shortage of millions of nurses in our country.
According to Zhang Guangpeng, deputy director (vice principal) of the National Health Commission's Cadre Training Center (Party School), the reason why the nurses have not been fully replenished is related to my country's investment in hospitals and the compensation mechanism.
As a public welfare institution, public hospitals face the embarrassment of self-financing and self-financing under the condition of insufficient financial investment. Most of the expenditures depend on the hospitals to provide medical services.
"In hospital management, part of the traditional concept is that doctors earn money and nurses do not earn money. In addition, the price of nursing services has been very low. Although there have been adjustments in recent years, it still cannot make up for the labor costs of nurses. Therefore, it is difficult for hospitals to invest. More funds to recruit more nurses." Zhang Guangpeng explained.
"Insufficient nursing resources are not a reason"
“Insufficient nursing resources are not the reason for the existence of nursing workers. This is a logical error.” An industry expert from a university in Beijing who did not want to be named said in an interview with reporters that the hospital allows the existence of nursing workers provided by a third party and the patients and family members pay for it. , Which is equivalent to the hospital transferring its own burden, nursing responsibility and risk. The correct approach should be to find ways to supplement nursing resources and eliminate nursing workers.
In fact, the “Notice on Strengthening Hospital Clinical Nursing Work” issued by the former Ministry of Health in 2010 has clearly stated that “gradually solve the problem of relying on the patient’s family or their family’s self-employed nurses to take care of the patient, and reduce the patient’s family burden”.
Many experts and scholars actively advise and provide advice on supplementing nursing resources and abolishing the path of nursing workers.
According to Li Ruonan, in some developed countries, “nurse assistants” and “assistant nurses” correspond to nursing workers in our country. Most of them are directly hired by hospitals. They are hospital employees and are directly managed by the hospital. At the same time, stricter occupational entry thresholds are set. A more scientific service classification system has been formed.
"You can consider exploring the assistant nurse education system, vocational secondary professional schools offer nursing (assistant nurse direction) professions, hospitals add assistant nurse positions, and undertake post-stage training and re-education tasks for assistant nurses, and clarify the occupational category, qualifications, and qualifications of assistant nurses. Rights and obligations, scope of work, etc." Li Ruonan suggested.
Li Mingzi, a professor at the School of Nursing at Peking University, believes that with the deepening of medical reforms, it is possible to consider expanding the scope of nurses’ functions and establishing a system for grading the use of nurses. Replacing nursing workers, broadening the career development space of nurses, adding nurse practitioners to registered nurses, etc., not only meets patients' needs for nursing services, but also enables nurses to enhance their sense of accomplishment and self-worth.
“We should neither allow registered nurses to take care of daily life such as feeding and wipe the body, nor should nurses be responsible for the basic nursing care that should be undertaken by nurses.” Li Mingzi explained that this can be solved by nurses' stratification and hierarchical practice. problem.
"At present, in addition to the hospitals not paying enough attention to the nursing team and investing in nursing human resources, the supervision department still lacks rigid indicators for the assessment of the bed-to-care ratio standards of public hospitals, and does not form rigid constraints on the hospitals." Li Mingzi pointed out.
For this reason, she suggested that while nursing workers should be abolished, the government should further increase the implementation of government investment in hospitals, establish policy guidance mechanisms, set assessment indicators for hospital nursing work, play the role of baton, and guide hospitals to strictly follow the characteristics and workload of different departments. , Patients’ conditions, etc., are equipped with corresponding nurse resources according to different bed-to-care ratios to ensure the stability of the nursing team.
Wang Yue, a professor at the School of Medical Humanities of Peking University, said that there are currently a large number of nursing staff. From the perspective of establishing a systematic medical support staff system, a group of outstanding personnel can be selected to promote the development of assistant nurses.
At the same time, nurses are graded, and different levels of nurses are assigned corresponding permissions based on different service content. For example, senior nurse practitioners can have part of the prescription rights, and assistant nurses are responsible for daily nursing and assistance.
In Zhang Guangpeng's view, the abolition of nursing workers is the proper meaning of strengthening the construction of the nurse team, and it is also in line with the overall trend of my country's medical reform.
According to the national medical reform plan, the government's investment responsibilities for public hospitals include 6 items including basic construction, purchase of large-scale equipment, and discipline construction.
With the six guarantees in place, public hospitals will naturally have more funds and space for the appointment and development of nurses, and improve the treatment of medical staff, including nurses.
In this regard, the national health authorities are also actively taking action.
In August 2020, the "Notice on Further Strengthening the Nursing Work of Medical Institutions" issued by the National Health Commission requires that medical institutions establish a nurse human resource allocation and flexible deployment system to ensure the needs of clinical care; it must be based on the characteristics of clinical departments and patient conditions Regarding the severity and workload of clinical nursing, the appropriate number and reasonable structure of nurses shall be allocated in accordance with the overall nursing work model of the responsibility system; the ratio of nurses in the whole ward of the second and above hospitals to the actual open beds shall not be less than 0.5:1, nurses in the intensive care unit The ratio of the actual open beds shall not be less than 2.5:1.
On September 4, 2021, the person in charge of the System Reform Department of the National Health Commission revealed that according to the high-quality development pilot tasks of public hospitals, my country will gradually increase the proportion of personnel expenditures to business expenditures, and strive to reach 45% by the end of the "14th Five-Year Plan" period. At the end of the "15th Five-Year Plan" period, we will strive to reach about 60%.
"This will have a clear guidance and even constraints on hospitals, tilt hospital expenditures to medical staff, make up for shortcomings in health human resources including nursing human resources, and establish a stable salary system for nurses." Zhang Guangpeng analyzed.
Liang Jialin, editor-in-chief of the "Healthy National Policy 2050" academic platform, puts forward three-stage proposal from the short-term, short-term, and long-term perspectives:
In the short term, taking the construction of the public health emergency system, especially the capacity building of hospital infection control, as an opportunity, the hospital nurses will be included in the unified management of the hospital awareness system, and the implementation of "from entry to resignation", "from hospital to discharge", and "from medical assistance to nursing care" "Closed-loop management.
In the short to medium term, with regard to the problem of insufficient nursing capacity in low-bed-to-care ratio hospitals, it is possible to gradually supply “blue-collar” nursing workers from housekeeping companies to upgrade to hospitals purchasing nursing services from specialized medical logistics service companies.
Drawing lessons from the "Double Penalty System" of the Drug Administration Law, for nurses' violations of laws and regulations in terms of medical quality and patient safety, both the nurses themselves are held accountable, and the legal representative and actual controller of the hospital logistics outsourcing company are held accountable.
From a long-term perspective, a transition period of 5 to 10 years for talent training can be set up, and the professional requirements of new nurses can be transferred from home economics to primary medical care in medical schools and vocational colleges under the mode of professional co-construction and talent training. learn.
Based on the supply level and ability model of the new type of caregivers, the professional authority of the medical assistants will be opened to the new type of caregivers in stages, and finally they will be integrated into the team of responsible physicians for management.