1 the background of exploring new ways of nurse grading management.
In 2005, the Ministry of Health held a national conference on nursing work, which was issued (Outline of China Nursing Development Plan (2005-20 10)). In 2006, the Health Department of Guangdong Province issued "Guangdong Nursing Development Plan (2006-20 10)" and "Nursing Management Standard", which clearly required health institutions at all levels to adjust the nurse structure according to the post responsibilities and technical level requirements of clinical nursing posts. Combine the job responsibilities and technical requirements of nursing posts with the hierarchical management of nurses, and give full play to the role of nurses at different levels. Zhujiang hospital, the predecessor of Southern Medical University, is the affiliated hospital of the First Military Medical University. In 2004, it was transferred to Guangdong Province with the collective transformation of universities. How to seize the opportunity in the dilemma of talent shortage, implement the outline and plan formulated by superiors, stabilize and develop the nursing professional team, and cultivate specialized talents? Therefore, we have made a series of explorations around the topic of "hierarchical management of nurses".
2. Explore a new method of nurse classification management.
2. 1 Hierarchical team structure, exploring the teaching of nurses in accordance with their aptitude: The nursing management standard issued by Guangdong Provincial Health Department in 2006 has set two steps for nurses' personal development. One is the professional step from ordinary nurses to specialist nurses, which is divided into four grades: assistant nurses (unregistered nurses), junior nurses on duty, senior nurses on duty and specialist nurses; The other is the administrative ladder from nursing team leader to head nurse, which is divided into three levels: nursing team leader, head nurse and head nurse [4]. These two steps jump out of the box of technical titles, solve the path of nurses' personal development, and give nurses more choices and opportunities for personal growth. In practice, we first sort out the relationship between its advanced standards and the theoretical two steps: unregistered nurses are assistant nurses, and nurses can complete five-year standardized training for junior responsible nurses within five years after registration, reach the core competence standards required by specialties, and can be promoted to senior responsible nurses; Senior responsible nurses are promoted to specialist nurses through the training of specialist knowledge, clinical practice and case accumulation, and through expert certification; Nurses with specialist qualifications can compete for the position of head nurse or director of nursing department through management courses. The head nurse is the assistant and backup candidate of the head nurse. The nursing team leader can choose to compete for the head nurse of the ward, or apply for the certification of the specialist nurse through the training of specialist knowledge and the accumulation of clinical practice, and obtain the qualification of the specialist nurse. The newly elected ward head nurse should have the experience of nursing team leader and good management ability; Senior responsible nurses can also train competing head nurses through management courses. Since 2006, according to the standard requirements formulated by our province, the nursing department and the personnel department have explored the mechanism of selecting nursing team leaders and head nurses with reference to academic qualifications and qualifications. The head nurse is the core of the nursing team in the department, and her position is not high but very important. Due to the expansion of hospital scale and the increase of beds, the hospital needs to increase the number of head nurses in clinical departments 10 at the end of 2007. The nursing department suggested to the organization and personnel department that the proportion of clinical practice ability assessment should be increased in the selection of head nurses when formulating the assessment conditions for head nurses to compete for posts. As a result, all the outstanding nursing team leaders in the clinical front line were selected, which played a positive guiding role. In view of the present situation that nurses in hospitals are young and have few backbones, we combine the responsibilities of nursing team leader and senior responsible nurse into one. Collectively referred to as the nursing team leader, each department has 3 ~ 4 nurses. When selecting the nursing team leader, we take the professional technical ability and the ability of organization, coordination and communication as the priority selection conditions of the nursing team leader, which not only selects a good example, but also stimulates the nurses' positive work enthusiasm and receives good expected results.
2.2 graded job responsibilities, nurses work as a team: in the process of graded management of nurses, actively advocate team culture and give full play to everyone's role.
The role of nurses in the team. At the end of 2006, the nurse scheduling mode was reformed synchronously, from discontinuous subsection scheduling to 8-hour continuous scheduling. We explore changing the working form of nurses' "individual combat", and organize a shift of nurses into a temporary working group, which is led by the nursing team leader to complete the work. We redefined the job responsibilities of nursing work in our class according to different levels. As the temporary team leader, the nursing team leader's main responsibility is to find and solve the nursing needs beyond the scope of patients' doctor's advice, and to lead and guide the junior responsible nurses to deal with the nursing problems of complex and difficult cases. Supervise the implementation of nursing measures; Handle nursing emergencies during shifts. The primary responsibility nurse's main task is to carry out the doctor's advice and nursing; The task of assistant nurses is to assist junior nurses to complete the life care and indirect care of patients, such as receiving 1 patients in new hospitals. The assistant nurse's duty is to arrange beds, confirm initial identity and register for admission; The primary responsible nurse on duty is responsible for detecting and recording the first vital signs, introducing the hospital environment, system and doctors and nurses of patients, and the nursing team leader (senior responsible nurse) makes a comprehensive admission evaluation of patients and makes a nursing plan. For example, the main responsibility nurse completes the preoperative preparation of the surgical patient, and the nursing team leader checks the implementation of the preoperative preparation and solves the problems in time. Facts have proved that under the premise of clear job responsibilities, nurses work in the form of teams, which is conducive to the complementary advantages and mutual supervision of nurses at different levels, thus reducing medical and nursing risks.
2.3 Stratified training objectives, training according to nurses' core competence: Guangdong Provincial Health Department is divided into five levels according to nurses' core competence, namely Nl: based on basic nursing competence; N2: Pay attention to the abilities needed for nursing critically ill patients; N3: Overall nursing practice ability and teaching ability; N4: undertaking scientific research and specialized nursing ability, N5: clinical nursing expert. Nurses who have worked in the hospital for less than 5 years account for 60% of the total number of nurses in the hospital, and the training task is very heavy. In this regard, according to the standard of core competence of specialized nurses, we have carried out pilot projects in operating rooms, critical care departments, hemodialysis and other departments, and explored the methods of cultivating nurses according to core competence, and achieved good results. The evaluation of core competence of specialized nurses includes two parts: quality description and actual operation statistics. First of all, in the pilot department, we asked nurses to evaluate themselves against the core competence standards. The results of self-assessment let nurses with different seniority see their own shortcomings. For example, a senior nurse said after the self-evaluation, the result surprised herself. I didn't expect T to be the backbone of the department business for many years, and the core competence of the specialty only reached the second-class standard. In the future, I should participate more in clinical practice and speed up the improvement of the core competence of specialists. Junior nurses are full of confidence in the standards, and believe that through hard work, they will be able to complete the training task as scheduled. Self-evaluation improves the enthusiasm and consciousness of nurses to participate in training. The results of the ability evaluation let the head nurse see the deficiency of management. In the past, they only emphasized the time and form of training, ignoring the pertinence and effect of training, which made nurses regard the burden of professional training for UIl women as indifference to repetitive and boring training, and it was difficult to receive good learning results. The new method is to train nurses according to their ability and the principle of filling vacancies, such as sending them for further study, short-term training in relevant departments, collective practice, demonstration of capable people and so on. The methods are diverse and targeted, which are well received by nurses.
3. To explore the effect of new level management of nurses.
In the practice of "graded management of nurses", we insist on solving the outstanding problems in the construction and management of nursing specialty based on the promulgated outline, planning and management norms, combined with the overall goal of hospital development and proceeding from the reality of the hospital. Through the practice and exploration of hierarchical management of nurses, preliminary results have been achieved. For example, young nurses have defined the direction of personal development, stimulated the enthusiasm for hard work, changed passive approach to active approach, and consolidated their professional foundation by serving patients. For another example, through selection, most senior nurses have served as nursing team leaders, and their work is not limited by doctor's advice. What patients need and what nurses can solve is their task. Their professional ability and personal value have been recognized and their sense of responsibility has been enhanced. Through serving patients, in recent years, nurses with high academic qualifications and professional titles in hospitals have insisted on working in the clinical front line, and some have served as specialist nursing team leaders, leading other members of the team to creatively carry out specialist nursing activities; Some of them were absorbed into the hospital nursing management Committee to make suggestions for the hospital nursing construction. The nursing department also actively recommends them to participate in various large-scale free clinics, consultations and other social activities organized by hospitals, academic groups and governments, so that they can get out of the hospital, understand the social demand for nursing services, and appreciate the value of nursing profession and the personal achievements of nurses. In short, the hierarchical management of nurses enables nurses at different levels in our hospital to find their own seats, so as to do their work with peace of mind. Health is the eternal goal pursued by human beings, and it is also the driving force and source of sustainable economic and social development [6]. Nursing service is continuous and dynamic in contact with patients.
Modality, directness and concreteness are directly related to patients' feelings and satisfaction with hospital services. Through practice, we think that the graded management of nurses must be combined with the actual situation of the hospital and adopt practical methods to speed up the construction of professional echelon. Personnel training and the rapid development of nursing discipline.