改善护士福祉：需求迫切，时机已到

增加就业机会是改善社会福祉的手段 #生活乐趣# #生活质量# #生活质量改善# #良好就业机会#

Full text

Nurses have faced extreme challenges in the past 2 years. Although all members of the critical care team have been affected by the COVID-19 pandemic, the impact on nurses has been disproportionately large. Critical care nurses are the frontline health care workers who have the most direct involvement with critically ill patients. Nursing care requires nearly constant presence at the patient’s bedside for extended periods, and caring for patients with COVID-19 is mentally, emotionally, and physically exhausting. The toll of the pandemic on nurses is illustrated by research that documents adverse effects including increased anxiety, sleep disturbances, and moral distress.1–3  By May 2021, about 115 000 nurses and health care workers had died of COVID-19.4  Nurses recognize these negative effects on the profession. A recent national survey of 6500 critical care nurses conducted by the American Association of Critical-Care Nurses (AACN) found that a stunning 92% of these nurses believe the pandemic has depleted nurses and will cut their careers short.5 

Despite widespread news coverage highlighting the struggles of frontline health care workers during the COVID-19 pandemic, public awareness of the realities of nurses’ experiences and the effect of nurses’ well-being on patient outcomes remains superficial and incomplete. The “Hear Us Out” campaign5  was launched in September 2021 by AACN to alert the public to the realities of COVID-19 care in intensive care units (ICUs) and to encourage vaccination. Vaccination is a crucial strategy that benefits individuals by reducing risk of critical illness and also benefits society by reducing ICU utilization. The health care system is unsustainable without high-quality, appropriately staffed nursing care; as the campaign points out, “A hospital without nurses can’t save your life.”5 

Staffing shortages in nursing, and particularly in critical care, have accelerated and become dire. Nursing shortages impact quality of care and patient outcomes, exacerbate nursing distress, and strain human and financial resources of health systems. In the AACN survey described above, 66% of the nurses who responded said that they have considered leaving the profession because of their pandemic experiences.5  A widely circulated September 2021 Associated Press News report stated,

The COVID-19 pandemic has created a nurse staffing crisis that is forcing many US hospitals to pay top dollar to get the help they need to handle the crush of patients this summer. The problem, health leaders say, is twofold: Nurses are quitting or retiring, exhausted or demoralized by the crisis. And many are leaving for lucrative temporary jobs with traveling-nurse agencies …6 

“Although nurses can practice self-care, nurse well-being cannot be solely the responsibility of the individual nurse; health care organizations must engage in systemic support for nurses’ resilience.”

The well-being of nurses is central to provision of health care and to the viability of health care systems. Although nurses can practice self-care, nurse well-being cannot be solely the responsibility of the individual nurse; health care organizations must engage in systemic support for nurses’ resilience.3  Fortunately, an evidence-based blueprint for improving nurse well-being exists. The central elements are encompassed in the standards of a healthy work environment. Healthy work environments enable nurses to practice in a manner that maximizes their contributions to patient and family outcomes and that has broad benefits not only for nursing and patients, but for all members of the health care team. Organizations with healthy work environments are better able to recruit and retain nurses and to deliver better patient outcomes and satisfaction; a healthy work environment can yield financial benefit. AACN has been committed to promoting creation of healthy work environments for 2 decades. Since 2001, AACN has continuously advocated for structuring the health care work environment to enable nurses to provide excellent care and has been instrumental in building the standards, supporting evidence, and resources for implementation of healthy work environments.

Six essential standards for establishing and sustaining healthy work environments have been articulated by AACN as follows:

Skilled Communication. Nurses must be as proficient in communication skills as they are in clinical skills.

True Collaboration. Nurses must be relentless in pursuing and fostering true collaboration.

Effective Decision-making. Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations.

Appropriate Staffing. Staffing must ensure the effective match between patient needs and nurse competencies.

Meaningful Recognition. Nurses must be recognized and must recognize others for the value each brings to the work of the organization.

Authentic Leadership. Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement.7 

Taken together, these standards enable nurses to control nursing practice, deliver excellent care, and be full partners in health care delivery. Healthy work environments maximize the contributions of nursing, improve nurse well-being, and have potential to mitigate the stresses accompanying pandemic ICU care. What is required is the will and the resources to create and maintain healthy work environments, and this commitment is even more urgent in our current crisis.

Despite the essential importance of healthy work environments to nurse well-being, much of the public conversation about recruitment and retention of nurses has centered on compensation. In our opinion, current compensation models have serious shortcomings that have destabilized health systems and further demoralized nurses. Large differentials in pay between the permanent nursing staff and the premium pay of temporary staff result in permanent staff feeling undervalued, as do recruitment incentives that are not accompanied by robust parallel retention incentives. The current situation has brought national attention to compensation issues; a more accurate assessment of the value and costs of nursing care is long overdue. Models of health care payment will need to change in order to recognize the essential contributions of nurses to patient outcomes; paying nurses and other health care workers less than they are worth subsidizes health care at the expense of those who provide it. However, although appropriate compensation is an important factor, a focus on pay as the only satisfier for nurses is misguided and will not solve the larger systemic problems underlying nursing distress.

Traditionally, January has been viewed as a time for new beginnings. Let our 2022 resolution be that we will work to establish and maintain healthy work environments in every acute and critical care setting. We have the knowledge and tools necessary to accomplish this resolution. Restoring the well-being of nurses through improving the health care work environment will have broad benefits for patients, families, the health care team, health systems, and society. The need is urgent, and the time is now.

“What is required is the will and the resources to create and maintain healthy work environments, and this commitment is even more urgent in our current crisis.”

全文翻译（仅供参考）

在过去的 2 年里，护士面临着极大的挑战。尽管重症监护团队的所有成员都受到了 COVID-19 大流行的影响，但对护士的影响却大得不成比例。重症监护护士是与重症患者接触最直接的一线医护人员。护理需要在患者床边长时间待在患者身边，而护理 COVID-19 患者在精神上、情感上和身体上都令人筋疲力尽。研究证明了大流行对护士造成的损失，这些研究记录了包括焦虑增加、睡眠障碍和道德困扰在内的不利影响。1 – 3 到 2021 年 5 月，约有 115 000 名护士和医护人员死于 COVID-19。4 护士认识到这些对职业的负面影响。美国重症监护护士协会 (AACN) 最近对 6500 名重症监护护士进行的一项全国性调查发现，惊人的 92% 的护士认为大流行已经耗尽了护士的资源，并将缩短他们的职业生涯。5 

尽管广泛的新闻报道强调了在 COVID-19 大流行期间一线卫生保健工作者的挣扎，但公众对护士经历的现实以及护士幸福感对患者预后的影响的认识仍然肤浅且不完整。AACN 于 2021 年 9 月发起了“倾听我们的声音”活动5 ，以提醒公众注意重症监护室 (ICU) 中 COVID-19 护理的现实，并鼓励接种疫苗。疫苗接种是一项关键策略，它通过降低危重疾病的风险使个人受益，并通过减少 ICU 的使用率来造福社会。没有高质量、配备适当人员的护理，医疗保健系统是不可持续的；正如该活动指出的那样，“没有护士的医院无法挽救您的生命。” 5 

护理人员短缺，特别是重症监护，已经加速并变得可怕。护理短缺会影响护理质量和患者预后，加剧护理压力，并使卫生系统的人力和财力资源紧张。在上述 AACN 调查中，66% 的回复护士表示，由于经历过大流行病，他们考虑过离开该行业。5 一份广为流传的 2021 年 9 月美联社新闻报道称，

COVID-19 大流行造成了护士人员配备危机，迫使许多美国医院付出高昂的代价来获得他们需要的帮助，以应对今年夏天大量患者。卫生领导人说，问题是双重的：护士正在辞职或退休，因危机而筋疲力尽或士气低落。许多人正在前往旅行护士机构从事利润丰厚的临时工作…… 6 

“虽然护士可以进行自我保健，但护士的健康不能完全是护士个人的责任；医疗保健组织必须为护士的应变能力提供系统支持。”

护士的福祉对于提供医疗保健和医疗保健系统的可行性至关重要。尽管护士可以进行自我护理，但护士的健康不能完全是护士个人的责任；卫生保健组织必须为护士的复原力提供系统支持。3 幸运的是，存在改善护士幸福感的循证蓝图。核心要素包含在健康工作环境的标准中。健康的工作环境使护士能够以最大化他们对患者和家庭结果的贡献的方式进行实践，并且不仅对护理和患者，而且对医疗保健团队的所有成员都有广泛的好处。拥有健康工作环境的组织能够更好地招聘和留住护士，并提供更好的患者治疗效果和满意度；健康的工作环境可以带来经济利益。20 年来，AACN 一直致力于促进创造健康的工作环境。自 2001 年以来，

AACN 阐明了建立和维持健康工作环境的六项基本标准，如下所示：

熟练的沟通。护士必须与临床技能一样精通沟通技巧。

真正的合作。护士必须坚持不懈地追求和促进真正的合作。

有效的决策。在制定政策、指导和评估临床护理以及领导组织运作方面，护士必须是受重视和忠诚的合作伙伴。

适当的人员配备。人员配备必须确保患者需求和护士能力之间的有效匹配。

有意义的认可。护士必须得到认可，并且必须认可其他人为组织的工作带来的价值。

真正的领导。护士领导者必须充分接受健康工作环境的必要性，真实地生活，并让他人参与其中。7 

总而言之，这些标准使护士能够控制护理实践，提供出色的护理，并成为医疗保健提供的全面合作伙伴。健康的工作环境可以最大限度地发挥护理的作用，改善护士的幸福感，并有可能减轻大流行病 ICU 护理带来的压力。所需要的是创造和维持健康工作环境的意愿和资源，而在我们当前的危机中，这一承诺更加紧迫。

尽管健康的工作环境对护士的幸福感至关重要，但关于招聘和留用护士的许多公开对话都集中在薪酬上。我们认为，目前的薪酬模式存在严重缺陷，破坏了卫生系统的稳定，进一步打击了护士的士气。长期护理人员和临时工作人员的薪酬之间的巨大差异导致长期工作人员感觉被低估，招聘激励措施没有伴随强有力的平行保留激励措施也是如此。目前的情况已经引起了国家对赔偿问题的关注；早就应该对护理的价值和成本进行更准确的评估。需要改变医疗保健支付模式，以认识到护士对患者预后的重要贡献；向护士和其他医疗保健工作者支付低于其价值的报酬，以牺牲提供医疗保健的人为代价来补贴医疗保健。然而，尽管适当的补偿是一个重要因素，但将薪酬作为护士唯一的满足是错误的，并且不会解决潜在的护理压力更大的系统性问题。

传统上，一月被视为新的开始。让我们的 2022 年决议是，我们将努力在每个急症和重症监护环境中建立和维护健康的工作环境。我们拥有完成这一决议所需的知识和工具。通过改善卫生保健工作环境来恢复护士的福祉，将对患者、家庭、卫生保健团队、卫生系统和社会产生广泛的好处。需求迫切，时机已到。

“所需要的是创造和维持健康工作环境的意愿和资源，而在我们当前的危机中，这一承诺更为紧迫。”

原文链接：

https://aacnjournals.org/ajcconline/article/31/1/4/31651/Improving-Nurse-Well-being-The-Need-Is-Urgent-and

本文由“健康号”用户上传、授权发布，以上内容（含文字、图片、视频）不代表健康界立场。“健康号”系信息发布平台，仅提供信息存储服务，如有转载、侵权等任何问题，请联系健康界（jkh@hmkx.cn）处理。

网址：改善护士福祉：需求迫切，时机已到 https://www.yuejiaxmz.com/news/view/134610

相关内容

深化金融研究 提升民生福祉
日本福祉介护康复等器具展
实践“积极老龄化”，提高老年群体生活福祉
心系民生福祉，倾力护航美好生活
增进民生福祉 提高生活品质质
楚雄州厚植民生福祉 解锁“幸福生活密码”
法兰克福机场必备贴士——自己那些事儿
呼和浩特分公司为老旧所站修缮房屋切实改善职工工作生活环境
从“安居”到“乐居”——长寿之乡四川雁江老旧小区改造侧记
哲学家对于幸福的论述

随便看看