Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals

Pei-Hsuan YANG ； Yao-Mei CHEN ； Li-Chuan WU ； Mei-Hsing CHEN ； Hsiu-Fen HSIEH

《The Journal of Nursing Research》 31卷1期 (2023/02) Pp. 1-8

https://doi.org/10.1097/jnr.0000000000000540

摘要

Background: A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model. Purpose: This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation. Methods: A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey. Results: Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation. Conclusions/Implications for Practice: Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.

關鍵字

nursing assistants ； hospital personnel administration ； personnel staffing and scheduling ； employee performance appraisal ； program evaluation

參考文獻

Chang, B.-Y., & Wang, K.-Y. (2013). Reflection on the application of skill-mixed care model in clinical settings. The Kaohsiung Journal of Nursing, 30(2), 1-10. https://doi.org/10.6692/KJN-2013-30-2-1 (Original work published in Chinese)

Cheng, W.-Y., Zheng, Y.-C., Hsu, Y.-L., Lu, H.-J., & Chu, T.-P. (2017). A project to improve clinical care and distress workload with the skill-mixing model. Chang Gung Nursing, 28(3), 450-462. https://doi.org/10.3966/102673012017092803006 (Original work published in Chinese)

Feng, R.-C., Sang, Y.-Y., Chang,W.-C., Chen, M.-M., Chou, S.-O., & Yin, T. J.-C. (2008). Establishment and evaluation of the skill-mix model in a medical center. VGH Nursing, 25(3), 249-258. https://doi.org/10.6142/VGHN.25.3.249 (Original work published in Chinese)

Huang, C.-I., & Lu, M.-S. (2017). The effectiveness of a strategy for the flexible management of nursing human resources: A pilot study. The Journal of Nursing, 64(6), 56-66. https://doi.org/10.6224/JN.000083 (Original work published in Chinese)

Li, H.-C.,Wang, H.-H., & Yang, M.-S. (2014). Reflecting on intention to stay of new nurses from postmodernism analysis of the effects of skill mix model: A literature review. The Kaohsiung Journal of Nursing, 31(3), 26-38. https://doi.org/10.6692/KJN-2014-31-3-4 (Original work published in Chinese)