Journal of Korean Clinical Nursing Research (임상간호연구)

Hospital Nurses Association (병원간호사회)
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A Study on Appropriate Nurse Staffing Levels in Intensive Care Units and Improvement of the Critical Care Nursing Fee Schedules

중환자실 적정 간호사 배치수준과 간호관리료 차등제 개선 연구

  • Lee, Hyo Jin (Department of Nursing, Asan Medical Center) ;
  • Cho, Sung-Hyun (College of Nursing, Research Institute of Nursing Science, Seoul National University) ;
  • Shim, Mi Young (Department of Referral Center, Seoul National University Hospital) ;
  • Kim, Jung Yeon (Department of Nursing, Severance Hospital) ;
  • Song, Yu Gil (Department of Nursing, Asan Medical Center) ;
  • Kim, Jin (Department of Nursing, Seoul National University Hospital) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine)
  • 이효진 (서울아산병원) ;
  • 조성현 (서울대학교 간호대학 간호과학연구소) ;
  • 심미영 (서울대학교병원 진료협력팀) ;
  • 김정연 (세브란스병원) ;
  • 송유길 (서울아산병원) ;
  • 김진 (서울대학교병원) ;
  • 김영삼 (연세대학교 의과대학 내과학교실)
  • Received : 2023.09.27
  • Accepted : 2023.10.25
  • Published : 2023.12.31
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Abstract

Purpose: This study attempted to analyze the staffing level and critical care nursing fees of intensive care units at tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing level and critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for the first quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted on nursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and 708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. Results: Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to 28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and 1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiary hospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in general hospitals, respectively. Conclusion: The appropriate staffing level was suggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0 (Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standard annual working days. It is expected to increase staffing levels and provide a better nursing work environment.

Keywords

Acknowledgement

본 연구는 2022년 병원간호사회에서 연구비를 지원받아 진행한 연구임.

References

  1. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: A systematic review. JAMA. 2002; 288(17):2151-2162. https://doi:10.1001/jama.288.17.2151
  2. Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care. 2007;45(12):1195-1204. https://doi.org/10.1097/mlr.0b013e3181468ca3
  3. Kane RL, Shamliyan T, Mueller C, Duval S, Wilt TJ. Nurse staffing and quality of patient care. Evidence Report/ Technology Assessment. 2007;(151):1-115.
  4. Driscoll A, Grant MJ, Carroll D, Dalton S, Deaton C, Jones I, et al. The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2018;17(1):6-22. https://doi.org/10.1177/1474515117721561
  5. Cho SH, Yun SC. Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: Cross-sectional analysis of survey and administrative data. International Journal of Nursing Studies. 2009;46(8):1092-1101. https://doi.org/10.1016/j.ijnurstu.2009.02.001
  6. Ministry for Health Welfare. Enforcement rule of the medical service act [Internet]. Sejong: Ordinance of the Ministry of Health and Welfare, No. 747; 2020 Sep 4 [cited 2023 Sep 1]. Available from: https://www.lawnb.com/Info/ContentView?sid=L000007863_B0005000_Y_20191008.
  7. Ministry for Health, Welfare and Family Affairs. The enactment of notification No. 2008-40 [Internet]. Sejong: Ministry of Health, Welfare and Family Affairs; 2008 [cited 2021 Mar 1]. Available from: https://www.mohw.go.kr/board.es?mid=a10409020000&bid=0026&act=view&list_no=320238&tag=&nPage=1.
  8. Health Insurance Review and Assessment Service. Providing reimbursed services in the national health insurance [Internet]. Wonju: Health Insurance Review and Assessment Service; 2023 Feb [cited 2023 Sep 2]. Available from: https://repository.hira.or.kr/handle/2019.oak/3076.
  9. Ministry of Health and Welfare. The enactment of notification No. 2018-116 [Internet]. Sejong: Ministry of Health and Welfare; 2018 [cited 2021 Mar 1]. Available from: https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=6872.
  10. Coffman JM, Seago JA, Spetz J. Minimum nurse-to-patient ratios in acute care hospitals in California. Health Affairs. 2002;21(5):53-64. https://doi.org/10.1377/hlthaff.21.5.53
  11. Massachusetts Health Policy Commission. Final ICU nurse staffing regulation [Internet]. Boston(MA): Massachusetts Health Policy Commission; 2017 Aug 27 updated [cited 2023 Sep 1]. Available from: https://www.mass.gov/doc/final-icu-nurse-staffing-regulation.
  12. Chamberlain D, Pollock W, Fulbrook P. ACCCN workforce standards for intensive care nursing: Systematic and evidence review, development, and appraisal. Australian Critical Care. 2018;31(5):292-302. https://doi.org/10.1016/j.aucc.2017.08.007
  13. Moreno R, Reis Miranda D. Nursing staff in intensive care in Europe: The mismatch between planning and practice. Chest. 1998;113(3):752-758. https://doi.org/10.1378/chest.113.3.752
  14. Ohbe H, Sasabuchi Y, Kumazawa R, Matsui H, Yasunaga H. Intensive care unit occupancy in Japan, 2015-2018: A nationwide inpatient database study. Journal of Epidemiology. 2022;32(12):535-542. https://doi.org/10.2188/jea.JE20210016
  15. Health Insurance Review and Assessment Service. Results of 2019(3rd) intensive care unit adequacy evaluation [Internet]. Wonju: Health Insurance Review and Assessment Service; 2020 Dec [cited 2023 Sep 1]. Available from: https://www.hira.or.kr/cms/open/04/04/12/2020_12.pdf.
  16. Lim CM, Kwak SH, Suh GY, Koh YS. Critical care in Korea: Present and future. Journal of Korean Medical Science. 2015;30(11):1540-1544. https://doi.org/10.3346/jkms.2015.30.11.1540
  17. Health Insurance Review and Assessment Service. Results of 2014(1st) intensive care unit adequacy evaluation [Internet]. Wonju: Health Insurance Review and Assessment Service; 2016 May [cited 2023 Sep 2]. Available from: https://www.hira.or.kr/cms/open/04/04/12/2016_14.pdf.
  18. Health Insurance Review and Assessment Service. Results of 2017(2nd) intensive care unit adequacy evaluation. [Internet]. Wonju: Health Insurance Review and Assessment Service; 2018 Aug [cited 2023 Sep 2]. Available from: https://www.hira.or.kr/cms/open/04/04/12/2018_13.pdf.
  19. Park MO, Yang EJ, Lee MM, Cho SH, Shim MY, Lee SH. The nurse staffing in intensive care units based on nursing care needs: A multicenter study. Journal of Korean Critical Care Nursing. 2021;14(2):1-11. https://doi.org/10.34250/jkccn.2021.14.2.1
  20. Park YS, Song RY. Estimation of nurse staffing based on nursing workload with reference to a patient classification system for a intensive care unit. Journal of Korean Critical Care Nursing. 2017;10(1):1-12
  21. Cho SH, Seong JY, Jung YS, You SJ, Sim WH. Recommendation for the Amendment of Inpatient Nursing Fee Schedules Based on Nurse Staffing Standards in General Wards of Tertiary Hospitals and General Hospitals. Journal of Korean Clinical Nursing Research. 2022;28(2):122-136. https://doi.org/10.22650/JKCNR.2022.28.2.122
  22. Ministry of Health and Welfare. Ministry of Health and Welfare Notice No. 2023-69 [Internet]. Sejong: Ministry of Health and Welfare; 2023 May 1 [cited 2023 Aug 31]. Available from: https://www.hira.or.kr/rc/drug/insuadtcrtr/bbsView.do?pgmid=HIRAA030069000400&brdScnBltNo=4&brdBltNo=52392&pageIndex=1&isPopupYn=Y#none.
  23. Ministry of Health and Welfare. Ministry of Health and Welfare-National Health and Medical Industry Workers' Union Agreement to overcome COVID-19, establish an infectious disease response system, strengthen public medical care, and resolve health and medical manpower issues [Internet]. Sejong: Ministry of Health and Welfare; 2021 [cited 2023 Sep 1]. Available from: https://www.mohw.go.kr/synap/doc.html?fn=1630518657667_20210902025058.pdf&rs=/upload/result/202311/.
  24. Oh IH, Kim YS, Lee KS. Pediatric intensive care unit and subintensive care unit operation model [Internet]. Sejong: Health Insurance Review and Assessment Service; 2015 Apr 6 [cited 2023 Aug 30]. Available from: https://repository.hira.or.kr/bitstream/2019.oak/1638/2/%EC%86%8C%EC%95%84%EC%A4%91%ED%99%98%EC%9E%90%EC%8B%A4%20%EB%B0%8F%20%EC%A4%80%EC%A4%91%ED%99%98%EC%9E%90%EC%8B%A4%20%EC%9A%B4%EC%98%81%EB%AA%A8%ED%98%95.pdf.
  25. Ministry of Health and Welfare. Ministry of Health and Welfare Notice No. 2018-116 [Internet]. Sejong: Ministry of Health and Welfare; 2018 Jun 21 [cited 2023 Aug 30] Available from: https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=6872#none.
  26. Queensland Government, Queensland Health(AU). Intensive care services: CSCF v3.2 [Internet] Brisbane(AU): Queensland Government; 2022 Oct 12 updated [cited 2023 Aug 20]. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444571/cscf-intensive-care-services.pdf.
  27. Ministry of Health and Welfare. Ministry of Health and Welfare Notice No. 2020-186 [Internet]. Sejong: Ministry of Health and Welfare; 2020 Aug 28 [cited 2023 Aug 20]. Available from: https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=8153.
  28. National Health Insurance Service. Announcement of performance evaluation indicators for integrated nursing care service providers in 2023 and guidelines for improving treatment of nursing personnel [Internet]. Wonju: National Health Insurance Service; 2022 Dec 19 [cited 2023 Aug 19] Available from: https://www.nhis.or.kr/_custom/nhis/_common/board/index/725.do?mode=view&articleNo=10830727&title.