醫院評鑑制度與護理人力規劃

醫院評鑑對於人力訂有標準來規範醫療機構，護理照護服務是病人照護的第一線，遍及醫院各角落，對於醫療機構的醫療、照護品質及成效影響之重要性自不可小覷。醫院評鑑制度2006年開始試行並推動重大的變革，2011年則將508條條文刪減為238條條文，並分為經營管理篇與醫療照護篇，2017年醫院評鑑改革方向再次從「簡化」、「優化」、「日常化」著手，醫院評鑑僅保留病人安全、醫療品質之內容，並能符合以病人為焦點之查證方式邏輯與國際趨勢，刪減非醫療核心的內容，如法令規範、教育訓練學分、公部門原該執行的事項等，與其他認證訪查重複之基準或評量項目，予以刪除或改為免評。護理人力的短缺，並不在於護理人員培育人數的不足，而在於護理人員的就業率和長期留任的意願偏低所導致。透過台灣護理界不斷的努力，醫院「全日平均護病比」已於2015年正式納入醫院評鑑條文中，亦於衛生福利部網站可查詢所有醫院的護病比，目前台灣努力將「全日平均護病比」納入醫療機構設置標準中，期許透過護病比與護理費給付連動，並獎勵與合理提升薪資，才能真正解決護理人力流失的問題，進而讓離開護理職場的人願意回流。

關鍵字

醫院評鑑；護理人力；護病比

並列摘要

Specifications of hospital staffing is developing in Taiwanese hospital accreditation system. Nursing care, as the first-line medical care, is important for quality and effectiveness of healthcare services. Hospital accreditation programs launched in 2006 and had experiencing significant changes. In 2011, the original 508 articles were reduced down to 238 articles, also divided those two chapters into operational management and medical care. In 2017, hospital accreditation reformed again and focused on ＂simplification＂, ＂optimization＂, and ＂routinization＂. As redundancy and non-essential items were removed, most retained articles are more specific to patient safety and healthcare quality that are in accordance with patient-centered care and global trends. The shortage of nurses in Taiwan is not a result of insufficient graduates from nursing schools. Apparently, the major problems are low employment rate and low desire to stay in nursing career. The endeavoring of nursing profession for decades have prompted policy changes, such as average daily nurse-patient ratios incorporate into hospital accreditation standards in 2015. Nowadays, the ratios are available to the public on the website of Ministry of Health and Welfare. Also, linking the reimbursement of nursing service fee to nurse-patient ratio could facilitate a reasonable remunerate. Sufficient staffing, balanced effectiveness and rewards will help retaining nurses and further attract the deserter back to the nursing profession.