Development of Nursing Profession - ShengJing Hospital of China Medical University

Development of Nursing Profession

Ⅰ Vertical Management of Nursing and Efficient Utilization of Human Resources

1. Vertical deployment of nursing staff in the care unit makes an efficient utilization of humane rsources

Thanks to the vertical management, the care unit succeed to make an total amount control and efficient disposal of nursing staff according to the different workload and the nature of the work in different sections. Now there are 2190 nurses in all. 83.3% of them are college degree or above.  Now we have ward nurses1459, hospital beds 4368 , beds-nurses ratio almost reaches 1:0.4, ICU beds-nurses ratio reaches 1:3, outpatient nurses 325, doctors 232, doctors-nurses ratio reaches 1:1.2

2004~2010 the change of nursing staff


We employed 1252 nurses since 2002 and carried out pre-service training and in-service training on young nurses. At present, three of them are about to become the head nurse’s assistants and will soon take up the nursing management positions.

 

2.  The Nursing Department Vertically Grant the Allowance, Fully Stimulate the Initiative of the Nursing Staff.

In 2005, after the nursing department carried out the performance appraisal system, the allowance of nurses are disposed according to the performance, position risk ,and job responsibilities. For example, the allowance of nurses in intensive care unit will be 300~600 yuan more than common nurses, this greatly fuel the positivity and initiativeness of working and avoid the phenomenon that nurses tend to go to non-superiority sections which have high workload but also high allowance like neurosurgery department, neurology, pediatric emergency, comprehensive emergency and so on.

Ⅱ  Nursing Care Service

1. Taking Patient as Center and Improving the Support System

(1)  In 2006, the hospital set up the fluid prepare center, logistics center, accompany center , drug dispensing machine and so on ,which largely decrease the nondirective nursing workload and time so that the nurse can give more time to the patients.
(2) In 2007, the nursing department replaced the original handwriting nursing records with forms. This saved 0.8 hour a day and almost one workday per week for the nurses so that nurses can do more for the patients.
(3) Since December 2009, PDA(portable movable Terminal) are used in the patient personal identification and nurse record input system, with the help of PDA, nurses can accurately, safely and quickly carry out the doctor's advice, infusion, blood transfusion, drug dispensing, record writing and so on.

 

2. Make “Satisfactory Project” and “Nursing Care brand”
Arm the nurses with new ideas of medical care to meet the increasing multilevel, multikinds need of  the patients.  From 2004 to 2009, we carried out the theme of improving service level based on the idea of “center on the patients”, such as the “Satisfactory Project” in 2004 and the service brand making in 2005. Make a detailed service system based on clinical work and do according to it. With the extensive efforts were made to improve the service level , we gradually receive favourable comments of the patients, the family, and also the doctors.

 

3 . Create Nursing Service “Demonstration Units”
We create “Nursing Service Demonstration and Attainment Unit”. Made 《Nursing Service Demonstration Unit Purpose and Application Details》,  《Service Demonstration Unit Standard》,《 Nursing Service Manners ,Standard Language and Behaviour》. Each sections have made their own standards to unify the patients checking process, pre-post operation take over process , morning-night take over process, check out process. Set up patients communication card and health direction card to give advises to patients about their eating, exercise, rest, living environment and something else related to their disease after they leave the hospital. As to today, there are already 32 care units passed the inspection, the top 8 are set as demonstration unit and the other 24 are attainment units. The competition promotes innovations of nurse care , expand and deepen the new service idea, largely improved the service level of the whole hospital.

4. Evaluation of the Effect of Nursing Service
(1)in the satisfaction survey from 2004 to 2009,the nursing service satisfaction improved as follows:

(2)A numerical statement of brocade banner, letters of commendation and “service star” after carry out the competition of nursing service demonstration and attainment unit:

nursing service demonstration unit

Total 50

service star

6 person-trips

brocade banner

7

letters of commendation

172 letters

letters of commendation of all sections

207letters

the percentage of demonstration unit in commendation letters

172/207=83%

5.  Create “High Quality Nursing Care Service Demonstration Project” Pilot Ward
In January, 2010, our hospital become one of the 72 main hospitals which carry out the “High Quality Nursing Care Service Demonstration Project” and start to dispose a health education psychologist, a diet and nutrition director, a  medication and nursing director in each of the six pilot wards. Everyday the on duty nurses are responsible for the health education in the morning, than the professional director will come to give more perfect recovering guidance in the afternoon.  So that the patients will get not only physical care but also mentally guidance.

Ⅲ  Nursing safety and nursing quality
ⅰ Nursing Safety Management

 

1. The hospital improved the management in 12 cases including wristbands system, transfusion medicine safety management system, transfusion medicine incompatibility management system, hospitalized patients accidentally tumble management system. Besides, we also set up a number of measures to prevent delirium patient’s accidents, insure the safety of patients transfer within hospital  and prevent slip of pipeline and so on.

 

2. We carry out programmed special topics training to head nurses and common nurses each quarter concerning patient safety management, work duty, avoids nurse care risk and others. Come up with a new idea of nursing safety----education from the alert analyze of nursing cases.

 

3. Enhance the monitoring on major department: in April this year, three deputy directors begin to weekly exam the disinfection and isolation quality in emergency room, hemodialysis room, operating theatre, ICU、CCU、NICU、PICU、EICU to insure the severe patient’ s safety besides the previous weekly exam of severe care quality.

 

4. Each member finish the disposed monitoring work according to monitoring contents set by the nursing safety quality control committee every month ,carefully analyze the problems and the measures to correct it, and fed back to the whole nurse staff to give an alert .

 

5. According to the principle of “center on cases and minor punishment”. We encourage the report of nursing cases, revise the management system, advocate non-punishment management of adverse event.

ⅱ Nursing quality management

1.The nursing quality management committee carry out whole staff participated three level quality control. 24 members are responsible for the daytime quality examination of the whole hospital; 86 head nurses are responsible for the nights and weekends. Nursing department is responsible for holidays and daily tracing exam. The setting of quality control group fully expressed the principle of “man-oriented, participation of the whole staff”.

2.nursing quality management committee meets quarterly, list the typical problems in quality control, concentrate on the clinical on-the scene director and details.

3. Accomplishment of nursing quality index

Table 4 the completion of nursing quality index

Project

Achieving Rate

critical nursing eligible rate

99.72%

Nursing record form eligible rate

97.56%

Emergency materials management eligible rate

98.49%

sterilize management eligible rate

98.11%

Severe errors(cases)

0

Accident pressure ulcer(cases)

1


Ⅳ Professional nurse culture

1. We have begun to train all kinds of professional nurse. After strict training, there are already 315 professional nurses acquired the certificate ,including 213  professional intensive care nurses, 42 venous transfusion nurses, 17 professional PICC nurses, 2 professional diabetes nurses, one enterostmal therapist, 40 professional rehabilitation care nurses.  This year professional bone marrow transplantation nurses are on training.

 

2. Three professional nurses training is the initiate in China.

Since March 2009, 287 backbone nurses attended the training of health education psychologist, drug-use director, and dietary director. The training is divided into two parts. Firstly, one month of academic training based on the self-made teaching materials of common course and professional course and then clinical practice for one month. The top 225 in academic performance can enter the professional skill examination. Now 78 certificated nurses are permitted to work and were unanimously praised!  37 of them are certificated in the first batch and the others passed in the second batch.

 

3. Professional Rehabilitation care nurses training

Director Zhang zhiqiang makes a training of 32 academic and 28 clinical skill classes to 82 backbone nurses. This training is based on pediatric neurology , pediatric orthopedics, neurology, neurosurgery, orthopedics, obstetrics, rehabilitation. After strict assessment, 40 nurses are certificated, and go into work on November first, 2009.

 

4.The training of the forth batch and the check of the second batch of the professional extensive care nurses.

After 2 months training, 56 nurses passes the exam in the forth batch, and 24 of the 38 second batch students are certificated in the recheck. Now, there are 213 extensive care nurses on work and played an important role in the treatment of H1N1 flue.


5. Develop the training of IV team (intravenous transfusion team)

(1) Unify the PICC operation process of neonates, infant, adults. In September, 2007, we set the first PICC outpatient section in Shenyang, make it more convenient for outpatients tube maintaining.

(1)  Take over the training of venous transfusion; PICC puncture consultation and liquor exude consultation. Finished 437 consultation (including venous indwelling acus, venous blood taking, venipuncture, PICC, chemotherapy drugs exude local blockage and so on)

 

6.The nursing department carry out the state-level  continuous medical education project and set up the “professional extensive care nurses ” and “tumor chemotherapy professional care and applications of PICC” training classes which  greatly improved the nursing level of the whole province.

 

7.Composition of the professional nurses

The grand total :566

Picture 2 the constitution of the nurses 

V  Nursing training

1.Pre-job training of new nurses

Including three stages: stage one, collective  lecture, the contents covered nursing general concept and service idea, quality requirement and manners of nurses, nursing risks prevention, nursing work system and nursing quality control. Stage two, clinical training receive clinical academic and skill training. Stage three, assessment, all staff should pass the assessment even through taking supplementary examination. 328 new nurses are certificated all the year round.

 

2.Basic nursing academic training and assessment   

positional titles

 nurse-in-chargeprimary nurseNurse

 

yearpopulationStandard—Achieving RatepopulationStandard—Achieving RatepopulationStandard—Achieving Rate

In 200923375.97%27375.82%99160.75% 

Table one the condition of the basic nursing academic exam

3. Basic nursing operation training and assessment

The hospital carry out 6 items nursing operation training and assessment. Firstly is the primary training and assessment in the sections, then all the nurses will take part in the sample examination hold by the nursing training committee, the person who doesn’t  pass the assessment should take the training again and make supplementary examination until certificated.

Assessment stages

 Operation itemsAssessment populationTotal average achievementeligible rate

Stage oneVenous transfusion27586 scores98%

Intramuscular injection

Stage twooxygen inhalation, suck sputum  per nasal26979 scores95%

Stage threeCPR、oral cavity  care33775  scores92%

yearly Summation 88180  scores95%

Table 2   statistics of basic nursing operation assessment in 20094. Three-basic tutor nursing operation assessment


4.In February, the nursing department carries out nursing operation assessment to the 86 three-basic tutors covering 6 aspects: venous transfusion, intramuscular injection, oxygen inhalation, suck sputum per nasal, CPR, and oral cavity care.

 

5. The academic and basic operation examination of head nurses.

At the beginning of the year, the nursing department carries out academic and 6 items operation assessment to the 86 head nurses. Academic average achievement is 86.2 scores; operation average achievement is 86.3 scores. This assessment is one of the indexes of annular comprehensive evaluation.

 

6. we hold 37 professional nursing lectures at noon in Nanhu branch, and 12 times in Huaxiang branch hospitals.  More than 7,000 nurses attended the lecture, and 3 nurses take out training, 30 people take short term training.

 

7. Approved center of Liaoning health department settle in our hospital

October, 2008, the approved center of Liaoning health department settled in our hospital, and take over the training of nurses in the whole province. April 8th 2009, the chairman of Liaoning health department Duan degang and the chairman Guo yanhong of the health ministry attended the unveiling ceremony of the center.

 

The center take mutikinds, multilevel training forms, students accumulated to 3744. among them, more than 300 nurses take 3 to 6 months long term training, 4 take one week to 3 months short term training, 38 of them take 2days to one week short term training.  The center have trained 2302 nurses on lectures and trained 1100 nurses through meetings and training classes.

Explain of the picture: chairman of Liaoning health department Duan degang and the chairman Guo yanhong of the health ministry attended the unveiling ceremony of the center.

Training date

Training contents

Attended

April 28 , 2009

nursing management  summit meeting of Liaoning province

More than 280

June 26, 2009

high grade  nursing management class of Liaoning province

More than 90

July 24th-26th,2009

state level tumor chemotherapy nursing and PICC application class

More than 150

July 24th-26th,2009

state level extensive care training class

More than 200

august 20th,2009

clinical education method and education management

More than 200

October 24th-26th, 2009

County hospital nursing manager training classes of Liaoning Province

About 180

Table 3 various levels training of nursing staff of Liaoning Province