"Whether it's day or night, as long as I go to work, the surgeries are one after another, non-stop." Li Mu (not her real name), an anesthesiology nurse at a tertiary hospital in Beijing, describes her daily routine.
Why is it so busy? In addition to the needs of the work itself, in her opinion, the lack of staff in the department is the main reason - there should be about 40 nurses to meet the daily rotation, but now there are only more than 20.
This phenomenon exists in many hospitals. In an interview with the Rule of Law Daily, a number of nurses said that the number of nurses there was generally "insufficient".
In May 2021, the General Office of the State Council issued the "Opinions on Promoting the High-quality Development of Public Hospitals", which proposed to increase the allocation of nurses and gradually increase the overall ratio of medical care in public hospitals to about 1:2.
However, according to the data released by the National Bureau of Statistics, the ratio of medical care to nurses is less than 1:1.2, and there is a huge gap in the number of registered nurses. The reason for this gap, in addition to high-intensity labor, low wages and a weak sense of professional honor have also led some nurses to choose to leave.
The interviewed experts suggested that the training of nursing staff should be increased, the treatment of nurses should be improved, the sense of professional honor should be enhanced, the financial expenditure on the medical industry should be increased, and the charging standards for nursing projects should be reformulated, including the nursing standards of self-pay and the nursing standards of the medical insurance catalog, so that the labor of nurses can be matched with the income, and the staffing of nurses should be implemented.
There is an inadequate allocation of nurses in the department
There are many people who are too busy to live
This year is Li Mu's 20th year in the nursing position. In her impression, as long as she walks into the department now, it means that the next 12 hours are busy, overtime is the norm, and there is no normal rest on holidays, and there will always be patients waiting for surgery.
At 8 o'clock in the evening on May 9, Li Mu, who had just finished a day's work, looked extremely tired when interviewed by reporters. She told reporters that she works from 8 a.m. to 4:30 p.m., but rarely leaves work on time:
At about 7:10 in the morning, she rushed to the department in advance to prepare surgical drugs and consumables according to the day's surgical arrangement.
At 8 o'clock, I took over the shift with my colleagues on the night shift, and after taking over the shift, I checked the surgical drugs with the pharmacy according to the doctor's instructions, especially the poisonous narcotic drugs, and then handed over the poisonous and narcotic drug packages that needed to be used in each operating room that day to each surgeon, and the chief surgeon signed and checked.
After distributing the surgical drugs, she began to patrol the stage, which is to help open the table in each operating room, do a good job in the logistics of the operating room, and ensure that the instruments, medicines, and consumables needed for the operation are in place and sufficient. Take a turn in each operating room, almost an hour.
During the doctor's operation, she also had to connect with the pharmacy about the use of surgical drugs, receive consumables, transfer patients, and pay attention to the needs of the operating room at any time.
At around 12 noon, the lunch box ordered by the anesthesiology department was delivered, because the operation in each operating room could not be stopped, so everyone distributed meals to ensure that the operating room could be supplied in time when needed. Doctors and nurses in the operating room can only eat after the operation.
After hurriedly eating the boxed lunch, she immediately went to work, preparing the surgical drugs for the afternoon, and at the same time locked the poisonous and narcotic drugs that were not used for the time being into the safe, and the two of them checked them when they entered the cabinet.
Then go to the warehouse to count the surgical consumables, check the surgical medication with the pharmacy, receive and check the ordinary drugs sent by the pharmacy, and go to each operating room to inspect the table to see whether the surgical process is smooth and whether the surgical consumables are sufficient......
When she returned to her workstation, the hour hand had pointed to 5 p.m., and her night shift colleagues had arrived to take over, but she had not finished her work when she was supposed to leave work. She began to check the surgical medicines, consumables and narcotic medicine packages sent back from the operating room, especially the narcotic medicine bags, which also needed to be carefully handed over, and then double-checked and put into the safe.
After all this, at about 6 o'clock in the afternoon, Li Mu had to go to the operating room to patrol the station again, and 4 of the 6 operating rooms on the day shift that day were still in operation, and she had to ask her colleagues if they needed to arrange dinner reservations.
After doing all this, she changed into her work clothes in the department and left the hospital with a tired face. It was already past 7 p.m., and 12 hours were fleeting.
"There is a shortage of nurses in our department." Li Mu sighed.
Ms. Chen, who works at another tertiary hospital in Beijing, also complained that a department of her hospital is also short of staff, with more than 20 beds in the ward and only 10 nurses at most.
"There are seventeen or eighteen patients in the ward all year round, and when we work the night shift, we are very busy." She said that the night shift was from 4:30 p.m. on the first day to 7:30 a.m. the next morning. After taking over the shift, first turn around the ward, and then give medicine to the patient according to the doctor's instructions, focusing on the medication for patients with special needs, such as sleeping pills, hypoglycemic drugs, etc., and then write a nursing record.
Ms. Yang, from a hospital in Tianjin, works 10 to 11 night shifts a month, taking care of nearly 40 inpatients a night, with only two nurses on duty.
Her department has more than 50 beds, and according to the requirements of the national health authorities, the bed-to-nurse ratio (the ratio of hospital ward beds to ward nurses) must not be less than 1:0.4. This means that the department would have to add more nurses to meet this standard.
"I worked at night, I was busy and tired, and I felt very tired." Ms. Yang said that she was on the night shift, measuring blood pressure and blood sugar for patients, giving infusions and dispensing medicines, and more than two hours passed after one round. "Newly admitted patients have to go through the admission process; Some patients have just undergone surgery and need to check their physical condition regularly; Some patients suddenly feel unwell in their hearts, and they should notify the doctor immediately......"
Some people change jobs, some leave
Attrition is severe
"Busy, not well-paid, high attrition." When recalling her experience working in the respiratory department, Yang Yi (pseudonym), a nurse in charge of the nursing department of a tertiary hospital in Guangdong Province, is still full of emotion.
Yang Yi is in her 30s and has been working as a nurse in this tertiary hospital for more than ten years.
At that time, after graduating with a bachelor's degree, she stood out among the applicants and was hired by this tertiary hospital. When asked which department she wanted to go to, she said enthusiastically, "I can go to whichever department I need, and I am not afraid to be busy." Eventually, she was assigned to the respiratory unit.
The respiratory department is a three-shift department, there are more patients, and there are wards, where coughing can always be heard. As a nurse, you need to travel back and forth between the treatment room, the nurses' station, and the patient room.
In addition to the general ward, there are many critically ill and seriously ill patients in the respiratory department, so a ward similar to the intensive care unit is set up, and the patients admitted to the respiratory ward must be directly intubated for rescue once they have respiratory failure. Therefore, in addition to doing some nursing work in the general ward, Yang Yi also has to participate in sudden rescue work.
On a night shift, in the early hours of the morning, a patient suddenly suffered from respiratory failure, and the doctor immediately arranged for rescue, but he did not come back until seven or eight o'clock in the morning, and then declared the patient dead. Yang Yi then wrote the nursing record, handed over the shift with the nurse, and it was almost noon when she was done. And she had already bought a ticket in advance to return to her hometown that day, but she missed it.
"The day shift usually leaves work at 4 o'clock in the afternoon, but it is often delayed until six or seven o'clock in the evening, and the night shift is supposed to leave work at 8 o'clock the next morning, but it often happens that it is delayed until 12 o'clock." Yang Yi said.
When she is not at work, Yang Yi still has to prepare for work - although she is resting at home, she is on call, and once there is an emergency in the department, she must rush back to the hospital immediately. One year in the thirtieth year of the Chinese New Year's Eve, she was having dinner when she suddenly received a call from the department, there was emergency rescue work, the department was too busy, she put down her chopsticks and rushed back to the department immediately.
As she grew older, Yang Yi found it difficult to adapt to the intensity of work and night shifts in the respiratory department, and she had a family to take care of, so she applied to be transferred to another department.
At present, only three of the many nurses who entered the respiratory department at about the same time as her remain in the respiratory department, and the others have either transferred to other jobs or left the hospital.
After working for many years, Yang Yi is still the nurse in charge, "In a tertiary hospital like ours, it is more difficult to promote professional titles, which requires not only years of work, but also research results, and work performance. Even if all of these conditions are met, they may not be promoted, because there are still quota restrictions."
Ms. Han, who has also worked as a nurse in a tertiary hospital in Beijing for more than 10 years, is deeply touched by this. She recalls that when she was a nurse in the ICU, there were many patients and few nurses, so she often had to work a large shift (24 hours) first, and could not go home directly after work, so she had to rest for a few hours in a dormitory specially vacated by the department, and then go to a small shift (8 hours) before returning home from work.
"The number of nurses has not increased for so many years, on the contrary, many nurses have been transferred from the clinical front line or even left because of too heavy work." Ms. Han said that she could not stand the pressure of such work and transferred to another department of the hospital.
Improve the treatment of nurses with respect
Ensure the healthy development of the team
In May 2021, the General Office of the State Council issued the "Opinions on Promoting the High-quality Development of Public Hospitals", proposing to increase the allocation of nurses and gradually increase the overall ratio of medical care in public hospitals to about 1:2.
In June 2023, the National Health Commission and the State Administration of Traditional Chinese Medicine issued the Action Plan for Further Improving Nursing Services (2023-2025), proposing to strengthen the staffing of nurses. Medical establishments should scientifically and reasonably allocate a sufficient number of clinical nurse manpower based on functional positioning, service radius, bed size, clinical nursing workload, and technical risk factors.
However, the 2023 National Economic and Social Development Statistical Communiqué shows that at the end of 2023, there were 12.47 million health technicians in the country, including 4.78 million licensed physicians and licensed assistant physicians, and 5.63 million registered nurses.
According to Yao Huaifang, a member of the Anhui Provincial Committee of the Chinese People's Political Consultative Conference and chief physician of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, this shows that the number of nurses in the mainland is very large. Based on these data, the national shortage of nurses is close to 4 million.
Yao Huaifang's investigation found that the current nursing resources of the hospital are difficult to meet the needs of patients, and nurses are still unable to cope with medical care, let alone let nurses take on the responsibility of nursing patients. According to the requirements of the national health authorities, the ratio of hospital beds to nurses should not be less than 1:0.4, that is, if there are 40 beds in a ward, there should be no less than 16 nurses, but now many hospitals are basically equipped with nurses below this number. In some hospitals, there are dozens of patients in the wards, and only two nurses are on duty at night, and "the nurses can't run around, and sometimes they don't even dare to admit new patients."
In Yao Huaifang's view, there are many reasons for this situation: on the one hand, there is a shortage of nurse practitioners. For example, during the new crown epidemic, nurses are at the greatest risk of infection, and there are some potential risks of infection, coupled with the low salary of nurses, and the contact with patients is often not respected, resulting in a large number of students graduating from nursing majors not engaged in the nursing industry. In addition, the phenomenon of hospital nurses choosing to leave their jobs and transfer jobs has increased, which has aggravated the shortage of nurses.
On the other hand, there is a shortage of nurses. At present, almost all hospitals have not strictly followed the requirements of the State Council to set up nurse posts, under the premise that the overall financial expenditure on medical care has not increased, the number of nurses has increased, the scope of nursing has expanded, the quality of nursing has been improved, and the corresponding nursing fee standards have not been introduced.
Deng Liqiang, executive director of the China Health Law Society and deputy director of Beijing Huawei Law Firm, believes that one of the reasons for the long-term shortage of human resources for nurses in mainland China is that the income of nurses is not proportional to the amount of work they undertake and the risks they undertake. The work of nurses includes life care and medical care during the hospitalization of patients, as well as a large number of clerical work, which is heavy and hard, but the pay is not high. Various statistics show that the salaries of nursing staff are relatively low in the entire medical system, resulting in a low evaluation of their profession by the nursing workforce.
In Deng Liqiang's view, nursing work is an indispensable and important part of medical work, "three points of treatment, seven points of care", this sentence directly reflects the importance of nursing work. However, this importance is not reflected in the management of hospitals, for many hospitals, experts, hardware facilities, medical equipment are important evaluation indicators, but it is difficult to see hospitals to take the ratio of nurses as an evaluation index. While the hospital prefers to introduce medical talents, it ignores the construction of the nursing team, and some hospitals even employ nurses in the form of employment or labor dispatch, which affects the stability of the hospital's nursing team.
Some interviewed experts believe that at present, in addition to the lack of attention to the nursing team and the insufficient investment in nursing human resources, the regulatory authorities still lack hard indicators for the assessment of the bed-to-nurse ratio standards in public hospitals, and there is no rigid constraint on hospitals.
Yao Huaifang suggested that the training of nursing staff should be increased, the treatment of nurses should be improved, and the society should be called on to respect nurses, increase financial expenditure on the medical industry, and reformulate the charging standards for nursing projects, including self-paid nursing standards and medical insurance catalogue nursing standards, so that nurses' labor can be rewarded, and the nurses will be equipped with nurses.
Deng Liqiang believes that the premise of increasing the number of hospital nurses is to improve the treatment of medical staff, especially front-line nurses. At present, the "Nurses Regulations" are sufficient to solve the problem of the positioning of nurses and the rights and obligations of nurses, and it is important for medical institutions to implement the provisions of the "Nurses Regulations", improve the level of awareness of nursing work, and ensure the treatment of nursing staff.
Yao Huaifang proposed that the Teacher Law and the Physician Law can be referred to, and the "Nurses Regulations" should also be upgraded to the Nurses Law, which can provide strong support for the long-term benign development of the nurse team.
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