Objective To explore the application effect of hierarchical management in clinical nursing management. Methods The management mode of graded responsibility system was implemented in hematology department of our hospital, and the nursing staff were stratified, and the nursing department and head nurse were assessed by post responsibility system and graded management, and the nursing quality results were analyzed. Results 95% of the nurses in the experimental group had a strong sense of job accomplishment, and their work enthusiasm was obviously improved, with a very positive rate of 87%. Conclusion Hierarchical management can effectively improve nursing quality, improve nursing effect, reduce the incidence of nursing defects, improve patient satisfaction, and help to carry out holistic nursing work more deeply and persistently.
Keywords: hierarchical management; Clinical nursing management;
The structural allocation of nursing staff and human resources is directly related to the quality and efficiency of nursing. At present, due to the unreasonable setting of nursing institutions in China, a series of management problems have emerged. For example, the task of treatment operation is heavy, and it is difficult for nurses to take patients as the center, which can not meet the various needs of patients and affect their satisfaction; The head nurse is in an overloaded workload environment, which leads to physical and mental fatigue, thus affecting the stability of the nursing team. Therefore, reforming unreasonable nursing manpower management mode and system, improving work order and improving work efficiency are the key points of nursing management. According to the job responsibilities and technical grade requirements of clinical nursing posts, our hospital organically combined the job responsibilities and technical grade requirements with the classified management of nurses, and gave full play to the role of nurses at all levels and achieved good results. The report is as follows.
1 data and methods
1. 1 general information 36 nurses were selected from our department from April 20 10 to April 20 12, all of them were female, with an average age of 27.5 years. Among them, there are 4 nurses in charge, 8 nurses, 2/kloc-0 nurses and 3 assistant nurses.
1.2 method
The control group was set up on 20/0-04-2013-00, and the experimental group was set up on 2010-02. The control group adopted the traditional management method, while the experimental group adopted the hierarchical management method of nursing posts.
1.2. 1 nursing level
Nurses are divided into four layers according to their professional titles, abilities and qualifications, which are divided into professional nurses, responsible nurses, operational nurses and assistant nurses in turn.
① Business nurse
Professional nurses are experienced senior nurses or nurses in charge, who guide and participate in the condition evaluation of critically ill patients, the formulation of nursing plans and the supervision of rescue work. Under the leadership of the head nurse, monitor the quality of daily nursing, analyze and identify nursing errors and accidents in wards, put forward corresponding corrective and preventive measures, and check hospitalized cases every week. Daily quality control of discharged medical records, and assist in organizing rounds. Analyze errors, accidents, nursing hidden dangers and nursing defects, put forward effective preventive and corrective measures, cooperate with new technology development and nursing research, conduct training and teaching, and be responsible for clinical teaching activities.
② Responsible nurse
The responsible nurse is assumed by a nurse with strong ability and deep qualifications. Applying nursing procedures under the guidance of superior nurses. Day nurses are responsible for all aspects of patients' care from hospitalization to discharge, such as psychological care, health education, treatment and basic care. Night nurses guide and supervise the completion of night nursing work to ensure that emergencies can be handled in time and correctly. Seriously implement the inspection system and handover work to prevent accidents and errors; Seriously implement the nursing system and basic nursing technical operation procedures, strictly follow the doctor's advice, and complete the nursing work accurately and timely.
③ Surgical nurse
A junior nurse or nurse serves as an operation nurse, who is mainly responsible for cleaning patients, ensuring nursing quality, cleaning ward environment, visiting and accompanying management, and completing various treatments and nursing work of patients under the guidance of the responsible nurse, including general education of patients before and after operation, disinfection and cleaning of articles, oxygen supply, nasal feeding, atomization treatment, vital sign measurement, indwelling catheter nursing patrol ward, taking medicine and helping the responsible nurse to care for critically ill patients, and is also responsible.
(4) Assistant Nurses Assistant nurses are junior nurses or unregistered nurses. Under the guidance of the nurse in charge, some nursing operations were carried out, including bed making, excreta treatment, morning and evening nursing, etc. , help the responsible nurse to complete the patient's life care.
1.2.2 scheduling method
(1) Patients in undergraduate wards from April 20 1 1 to April 20 12 were taken as the experimental group, and assistant nurses, operating nurses and responsible nurses were taken as the responsible groups to take care of the patients in this group. Professional nurses and responsible nurses work in the day shift for half a year to one year, and do not participate in night shift rotation. Assistant nurses rotate to ensure a comprehensive understanding of the patient's situation. It is convenient for timely and correct handling of emergency special situations.
(2) In order to ensure the quality of nursing work during abnormal working hours and prevent accidents and mistakes, the second-line nurse duty system is implemented, and both professional nurses and responsible nurses participate in the second-line duty to guide the T work of junior nurses at any time. Ensure that the second-line nurses patrol the ward 24 hours a day, ensure the thorough implementation of the nursing work for critically ill patients, guide the handling of difficult operations and sudden emergencies, and ensure the nursing quality of the head nurse after work.
(3) Due to the different responsibilities of nurses at all levels, the emphasis of training and assessment is also different. Professional nurses mainly cultivate the ability of scientific research, teaching and management: duty nurses mainly cultivate the nursing of critically ill patients, new medical care and new technology; Surgical nurses mainly train professional knowledge; Assistant nurses focus on training basic clinical operation. According to the different training contents, the assessment is conducted at different levels.
1.3 curative effect evaluation index
(1) nurses' sense of job accomplishment, patients' and doctors' satisfaction with nursing work. Methods: An anonymous questionnaire was used to investigate nurses' sense of job accomplishment, and the results were divided into three grades: low, medium and strong. The satisfaction of patients and doctors was investigated by anonymous questionnaire. The contents include nurses' care and communication with patients, nurses' health education and service attitude, and nurses' timeliness in meeting patients' needs. Score the survey results.
(2) Theoretical scoring of nurses' operational skills and knowledge: The nursing department and senior nurses scored the operational skills and theoretical knowledge of the two groups of nurses, and scored the quality of nursing work, including basic nursing, first-class nursing, nurses' quality and nursing writing. Full score 100, excellent standard above 85, passing score 60.
(3) Self-evaluation and self-evaluation of nurses' work enthusiasm: The validity and reliability of the questionnaire should be guaranteed. According to the results of anonymous survey, enthusiasm is divided into three grades: poor, average and very positive.
1.4 statistical method
Statistical software SPSS 13.0 was used for analysis, and counting and measurement data were processed by X test and T test respectively, P
Two results
2. 1 Comparison of nursing quality scores between two groups
After the implementation of management, 95% of the nurses in the experimental group had a strong sense of accomplishment and their work enthusiasm was obviously improved, with a very positive rate of 87%. In the control group, 62% nurses have a strong sense of accomplishment and their work enthusiasm remains unchanged. The very positive rate was 565,438 0%. The difference between the two groups was statistically significant (P
2.2 Comparison of patient satisfaction between the two groups
By adopting hierarchical management, compared with the control group, the nursing quality of the experimental group was significantly improved, and the patient satisfaction was also significantly better than that of the control group, with statistical significance (P
3 discussion
For patients, nurses are doctors' assistants and collaborators, and nursing work has an important impact on the prognosis of patients' diseases. Relatively fixed nurses are responsible for the care of patients 24 hours a day, which has continuity for the care of patients and closer cooperation between nurses. Strictly and conscientiously hand over the shift, improve the nurse's initiative and specialist nursing skills. At the same time, the nurses on duty are relatively fixed, which increases the understanding between nurses and doctors and makes the relationship between doctors and nurses closer. In the process of carrying out the doctor's advice, the nurse timely feedbacks the patient's condition to the doctor and puts forward reasonable suggestions to make the doctor-patient relationship more harmonious.
Hierarchical management provides a platform for senior nurses to show and develop their self-abilities, fully embodies the responsibility of helping, inheriting and leading, and improves their sense of value and professional satisfaction. The relatively fixed responsibility group makes the nursing work be completed by the group instead of the executor, which makes the nursing service more meticulous and thoughtful, effectively implements the nursing measures, and improves the patient satisfaction and nursing quality. At the same time, grading management also broadens the personal career development space of nurses, and everyone participates in ward management and quality management, which has played a positive clinical role in comprehensively improving nursing quality.
To sum up, through the application of hierarchical management model in clinical nursing management, the nursing team structure and nursing workflow can be optimized, which not only meets the needs of patients, improves patient satisfaction, but also plays a positive role in training and management. Improving nursing quality in an all-round way is the best operation mode for the standardized, professional and scientific development of nursing discipline.
refer to
Gao Hua, He. Application of hierarchical management model of nurses in clinical nursing management [J]. Nursing Practice and Research, 20 1 1, 8 (7): 76? 77.
[2] Qiao Lina, Che, et al. Study on the effect of hierarchical management mode of nursing posts in clinical application [J]. Nursing Research, 20 10/0,24 (7c):1952? 1953.
[3] Tang Shilian, Ling Shaoju. Ying chuan. application of hierarchical management in clinical nursing [J]. chinese medicine modern distance education of china 2Ol0 (19): 136? 137.
[4] As we all know, the application of quality management in nursing management [J]. Medical information, 20L0,23 (8): 238? 239.
[5] Lu Gendi, Yang Yajuan. Practice and experience of high-quality nursing demonstration project [J]. Journal of Nursing of the People's Liberation Army.2010,27 (12b):1904? 1905.
[6] Hong, Hui, Guo Shaoxia, et al. Application of ten-level management in clinical post responsibility system [J]. ordinary care, 2009,7 (10b): 2702-2703.
[7] Wei Li, Peng Yueming, Cao Jing. Application of hierarchical nursing management mode in ICU nursing management. Modern clinical nursing, 20 1 1, 10 (4): 56? 58.
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