Journal of Korean Clinical Nursing Research (임상간호연구)

Hospital Nurses Association (병원간호사회)
권호 표지
DOI QR코드

DOI QR Code

Recommendation for the Amendment of Inpatient Nursing Fee Schedules Based on Nurse Staffing Standards in General Wards of Tertiary Hospitals and General Hospitals

상급종합병원과 종합병원 일반병동의 간호관리료 차등제 간호사 배치기준 및 수가체계 개선방안

  • Cho, Sung-Hyun (College of Nursing.Research Institute of Nursing Science, Seoul National University) ;
  • Seong, Jiyeong (College of Nursing, Seoul National University) ;
  • Jung, Young Sun (Department of Nursing, Asan Medical Center) ;
  • You, Sun Ju (Department of Nursing, Mokpo National University) ;
  • Sim, Won Hee (Department of Nursing, Seoul National University Hospital)
  • Received : 2022.05.31
  • Accepted : 2022.06.24
  • Published : 2022.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study attempted to recommend a revision of inpatient nursing fees based on analyzing current and appropriate staffing levels. Methods: Staffing grades and their inpatient nursing fees as of the first quarter of 2022 were analyzed. Nurse managers and staff nurses answered surveys about the current and appropriate staffing levels, working days, and monthly salary. A total of 101 nurse managers and 588 staff nurses working in general wards at tertiary hospitals and general hospitals participated in the study. Results: The results showed that grade 1 staffing was found in 73.3% of tertiary hospitals and 63.7% of general hospitals. The current staffing ratios of tertiary hospitals and general hospitals were 1:9.3 and 1:10.4, respectively. The appropriate staffing ratios according to nurse managers and staff nurses at tertiary hospitals were 1:7.6 and 1:7.0, respectively, and 1:8.7 and 1:8.8 in general hospitals, respectively. The average estimated annual working days of staff nurses were 235.2 days in tertiary hospitals and 240.0 days in general hospitals. The median monthly salary for staff nurses was 4.957 million won in tertiary hospitals and 4.140 million won in general hospitals. The new staffing grade system was suggested from 1:6 (Grade 1) to 1:12 (Grade 5). The new inpatient nursing fee schedules were recommended to be paid based on nursing hours per patient day of each grade. Conclusion: The new staffing grade and inpatient nursing fee schedules are expected to increase staffing levels, improve the quality of nursing care, and provide a better work environment for nurses.

Keywords

Acknowledgement

본 연구는 2021년 병원간호사회에서 연구비를 지원받아 진행한 연구임.

References

  1. Ministry of Health and Welfare. Partial revision of the public notice: List of benefits and non-benefits for treatment materials and the upper limit of benefits table (Notice No.2019-177) [Internet]. Sejong: Ministry of Health and Welfare; 2019 Aug 5 [cited 2022 Mar 31]. Available from: http://www.mohw.go.kr/react/jb/sjb0406vw.jsp?PAR_MENU_ID=03&MENU_ID=030406&CONT_SEQ=350426&page=1.
  2. Medical service act [Internet]. Sejong: Korea Ministry of Government Legislation, Korean Law Information Center; [updated 2020 Dec 29; cited 2022 Jul 10]. Available from: https://www.law.go.kr/법령/의료법.
  3. Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies. 2022;134:104311. https://doi.org/10.1016/j.ijnurstu.2022.104311
  4. Cho SH, Mark BA, Knafl G, Chang HE, Yoon HJ. Relationships between nurse staffing and patients' experiences, and the mediating effects of missed nursing care. Journal of Nursing Scholarship. 2017;49(3):347-355. https://doi.org/10.1111/jnu.12292
  5. Cho EH, Sloane DM, Kim EY, Kim SR, Choi MY, Yoo IY, et al. Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies. 2015;52(2):535-542. https://doi.org/10.1016/j.ijnurstu.2014.08.006
  6. Shin SJ, Park JH, Bae SH. Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook. 2018;66(3):273-282. https://doi.org/10.1016/j.outlook.2017.12.002
  7. Cho SH, June KJ, Kim YM, Cho YA, Yoo CS, Yun SC, et al. Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. Journal of Clinical Nursing. 2009;18(12):1729-1737. https://doi.org/10.1111/j.1365-2702.2008.02721.x
  8. Ministry of Health and Welfare. Notification of the 4th tertiary hospitals ('21~'23) designation plan. Sejong: Ministry of Health and Welfare; 2020 Jun 29 [cited 2022 Jul 25]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=355180&page=1.
  9. Cho SH, Lee JY, Hong KJ, Huh I. The relationship between average length of stay and nurse staffing in general hospitals from 1996 to 2016. Journal of Korean Academy of Nursing Administration. 2020;26(5):521-532. https://doi.org/10.11111/jkana.2020.26.5.521
  10. Shamian J, Hagen B, Hu TW, Fogarty TE. The relationship between length of stay and required nursing care hours. Journal of Nursing Administration. 1994;24(7):52-58. https://doi.org/10.1097/00005110-199406000-00014
  11. Health Insurance Review & Assesment Service. Health insurance benefit costs (2022 February edition) [Internet]. Wonju: Health Insurance Review & Assesment Service; 2022. [cited 2022 Mar 31]. Available from: https://repository.hira.or.kr/handle/2019.oak/2964.
  12. Tompson Reuters Westlaw. Barclays official California Code of Regulations. Title 22 CA ADC § 70217: Nursing service staff [Internet]. New York: Tompson Reuters Westlaw; 2013 [cited 2022 Jul 12]. Available from: https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?contextData=%28sc.Default%29&transitionType=Default.
  13. Martin T, Boardley G. NHpPD application manual: Guiding principles [Internet]. 2019 Rev. ed. Government of Western Australia, Department of Health; 2019 Aug 29 [cited 2022 Jul 10]. Available from: https://ww2.health.wa.gov.au/~/media/Files/Corporate/general-documents/nursing-and-midwifery/PDF/NHpPD-Guiding-Principles.PDF.
  14. Cho SH, Lee JY, Hong KJ, Yoon HJ, Sim WH, Kim MS, et al. Determining nurse staffing by classifying patients based on their nursing care needs. Journal of Korean Academy of Nursing Administration. 2020;26(1):42-54. https://doi.org/10.11111/jkana.2020.26.1.42
  15. Ministry of Health and Welfare, Korean Health and Medical Workers' Union. Agreements to establish a response system for infectious diseases, public health care, and healthcare workforce [Internet]. Sejong: Ministry of Health and Welfare; 2021 Sep 2 [cited 2022 Mar 31]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=50&CONT_SEQ=367103&SEARCHKEY=DEPT_NM.
  16. Cho SH, Hong KJ, Jung EH. Analysis and improvement plans for nursing shifts based on the government guidelines for night shift work. Seoul: Hospital Nurses Association; 2020 Dec. p. 1-54.
  17. National Health Insurance Service. Comprehensive nursing service guidelines: Q&A. Seoul: National Health Insurance Service; 2015.
  18. Cho SH, Yoon HJ, Chang SJ, Lee JY, Sim WH, Kim MS, et al. Development of a web-based solution for patient need-driven staffing to determine nurse staffing requirements. Journal of Korean Academy of Nursing Administration. 2022;28(3):238-250. https://doi.org/10.11111/jkana.2022.28.3.238
  19. Park SK, Kim JE, Lee HJ, Jwa YK, Kwak MS, Kim YS, et al. National medical care resources and utilization survey [Internet]. Sejong: Ministry of Health and Welfare, Korea Health Industry Development Institute; 2017 Nov 30 [cited 2022 Jul 12]. Available from: http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=344184.
  20. Cho SH, Jung YS, Yoo SJ, Sim WH, Seong J. Recommendation for the amendment of inpatient nursing fee schedules based on nurse staffing standards in general wards. Seoul: Hospital Nurses Association; 2022 May. p. 1-123.
  21. Health Insurance Review & Assessment Service. Status of hospitals and pharmacies nationwide [Internet]. Wonju: Health Insurance Review & Assessment Service; 2022 [cited 2022 Mar 31]. Available from: http://opendata.hira.or.kr/op/opc/selectOpenData.do?sno=11925.
  22. Health Insurance Review & Assessment Service. File of fee schedules for medical, dental and oriental medical services [Internet]. Wonju: Health Insurance Review & Assessment Service; 2022 Feb 1 [cited 2022 Mar 31]. Available from: http://www.hira.or.kr/rd/insuadtcrtr/bbsView.do?pgmid=HIRAA030069000400&brdScnBltNo=4&brdBltNo=52062&isPopupYn=Y.
  23. Health Insurance Review & Assesment Service. Guidelines for reporting differentiated inpatient nursing fees by staffing grade in general wards(based on the number of patients) [Internet]. Sejong: Health Insurance Review & Assesment Service; 2018 [cited 2022 Mar 31]. Available from: https://www.hurb.or.kr/hira_sg/index.jsp.
  24. Labor standards act, Article 60(annual paid leave) [Internet]. Sejong: Korea Ministry of Government Legislation, Korean Law Information Center; [updated 2021 May 18; cited 2022 Mar 31] Available from: https://www.law.go.kr/법령/근로기준법.
  25. Cho SH, June KJ, Kim YM, Park BH. Changes in hospital nurse staffing after implementing differentiated inpatient nursing fees by staffing grades. Journal of Korean Academy of Nursing Administration. 2008;14(2):167-175.
  26. Cho SH, Chang SJ, Ryu HG, You SJ, Lee JY, Hong KJ, et al. Development of an evaluation system of the nurse staffing appropriateness for providing comprehensive nursing care service. Wonju: National Health Insurance Service; 2019. Report No.: 2018-2-0014.
  27. Cho SH, Hong KJ, Yoon HJ, Chang SJ, Choi KH, Park HJ, et al. Estimation of expected nursing hours based on patients' nursing care needs and a comparison with actual nursing hours in comprehensive nursing care wards. Journal of Korean Academy of Nursing Administration. 2020;26(4):365-377. https://doi.org/10.11111/jkana.2020.26.4.365
  28. National Health Insurance Service. 2022 Standard guidelines for comprehensive nursing care service [Internet]. Wonju: National Health Insurance Service; 2022 Mar 1 [cited 2022 Mar 31]. Available from: https://www.nhis.or.kr/nhis/together/wbhaea01000m01.do?mode=view&articleNo=10815472.
  29. Whang NM, Kim DJ, Shin YS, Kim JY, Kim SW, Jang IS, et al. Institutionalization of comprehensive nursing care service hospitals. Wonju: National Health Insurance Service; 2014. Report No.: 2014-76.
  30. Shin HW, Lee SY, Jung HS, Yeo NG, Kim JH, Oh SJ, et al. Plans to develop comprehensive nursing care service system and improve its incentive system. Wonju: National Health Insurance Service; 2016. Report No.: 2016-071.