北京市优质护理服务现状调查与对策研究

目的 了解北京市优质护理服务现状，分析问题原因并提出对策。方法 个人深入访谈法与定性分析法。结果 北京市优质护理服务完成了从个别试点到全面铺开，从形式要求到内涵建设的转变，取得患者、医生、医院、社会、政府多方满意的实效。但面临队伍不稳定，离职率逐年上升的突出问题，主要原因是：（1）护理服务价格体系调整滞后；（2）护理人员不足；（3）护理人员的职业前途不清晰；（4）职称晋升与医生平台相同；（5）待遇分配体系中护理人员没有更多的话语权。对策建议包括（1）理顺护理服务价格，采取按护理项目收费模式；（2）人员编制逐渐向护理人员倾斜；（3）分管理型、教学型、临床型、专科型和科研型五类护理专家，制定相应的职业发展规划；（4）制定过渡性的、独立的护理人员职称晋升与评定标准；（5）创造条件赋予护理人员更多话语权，提高分配体系中护理人员分配额度。结论 优质护理服务作为推动新一轮医药卫生体制改革及公立医院的重要抓手，随着改革进程的推进，成绩和问题并存，有必要较深入地了解北京市优质护理服务的现状、问题并分析原因、探讨对策，促进优质护理服务的可持续发展。

Status Quo Survey and Solutions of Excellent Quality Nursing Services Project in Beijing

Objective To understand the status quo and problems of Excellent Quality Nursing Services Project in Beijing, and search causes and solutions. Methods Using in-depth interview and quantity analysis method. Results Excellent Quality Nursing Services Project in Beijing has been changed from respective to allover pilot, and from form to connotation construction, and has gotten effectiveness of multi-satisfaction from patients, doctors, hospitals, society, and government. But problems are still serious, that is, staffs are unsustainable, and the rate of off-job is rising year by year. Main reasons are as follows: (1) Service price system of nursing coordinately lags behind; (2) Nursing staffs are scarce; (3) Career prospect of nursing staffs is indistinct; (4) Stage of title promotion is the same as doctors; (5) No more voice is held by nursing staffs in distribution system. Solutions are as follows: (1) To coordinate the service price of nursing, take the mode of fee-for-service; (2) To lean gradually to nursing staffs on size of personal force; (3) To make relevant planning of career development, and to separate them into five series of nursing specialist, such as managerial, teaching, clinical, specialized and scientific researching competence; (4) To set transitional independent indicators on title promotion and evaluation for nursing staffs; (5) To entrust more discursive power to nursing staffs by creating conditions, in order to expand the lines in distribution system. Conclusion Excellent Quality Nursing Services is an important measure that promotes the new round of medical and health system reform and public hospital reform. Performance and problems are co-existence while process of reform is boosted. It is necessary to realize more deeply what is status quo, problems and countermeasures of Excellent Quality Nursing Services project in Beijing to promote the sustainable development of the project.