의료기관의 일반병동, 성인 중환자실, 신생아 중환자실의 간호등급 변화

홍경진,조성현 병원간호사회 2017 임상간호연구 Vol.23 No.1

Purpose: This study aimed to explore the distributions of nurse staffing grades and to report changes in staffing grades in general wards and adult and neonatal intensive care units(ICUs) by hospital type and location. Methods: Data collected from the Health Insurance Review and Assessment Service were analyzed. Nurse staffing was categorized from grades 1 to 6 or 7 for general wards, 1 to 9 for adult ICUs, and 1 to 4 for neonatal ICUs based on the nurse-to-bed ratio. Results: The staffing grade for the general wards improved during 2008 -2016 in 69.8% of the tertiary hospitals, 58.5% of the general hospitals, and 31.7% of the non-general hospitals. The adult ICUs at tertiary hospitals exhibited a greater improvement in staffing grades (48.8%) than did those of general hospitals (44.2%) during 2008-2015. Tertiary hospitals in non-capital regions showed a greater improvement than those in the capital region. The majority of neonatal ICUs (67.1%) had no change in the staffing grade during 2008-2015. Conclusion: Improvements in nurse staffing differed by hospital type and location. Government policies to improve nurse staffing in non-tertiary hospitals and those in non-capital regions are required to reduce variations in nurse staffing. 목적: 본 연구는 의료기관의 일반병동, 성인 중환자실, 신생아 중환자실 간호등급을 의료기관 종별, 지역별로 구분하여 그 분포를 탐색하고, 간호등급 변화를 설명하는 것을 목적으로 한다. 방법: 건강보험심사평가원으로부터 구득한 자료를 분석에 활용하였다. 간호등급은 병상수 대 간호사수의 비를 바탕으로, 일반 병동은 1등급 내지 6등급 또는 7등급, 성인 중환자실은 1등급 내지 9등급, 신생아 중환자실은 1등급 내지 4등급으로 구분하였다. 결과: 일반병동의 간호등급은 2008년과 2016년 사이에 상급종합병원의 69.8%, 종합병원의 58.5%, 병원의 31.7%에서 향상되었다. 성인 중환자실의 경우 2008년과 2015년 사이에 간호등급이 향상된 기관은 상급종합병원이(48.8%) 종합병원(44.2%)보다 많았다. 결론: 간호등급 향상 여부는 의료기관 종별, 지역별로 차이가 있었다. 간호등급의 편차를 줄이기 위해 상급종합병원 이외의 의료기관과 비수도권 지역 의료기관의 간호등급 향상을 위한 정책이 요구된다.

간호관리료 차등제 개정과 야간간호료 신설의 정책효과: 간호등급 변화와 간호사 처우개선비 추정

조성현(Cho, Sung-Hyun),홍경진(Hong, Kyung Jin),이지윤(Lee, Ji-Yun) 한국간호행정학회 2021 간호행정학회지 Vol.27 No.3

Purpose: To analyze the changes in nurse staffing grades and to estimate the revenue growth generated by applying government guidelines for improving nurses’ working conditions. Methods: Staffing grades, ranging from grade 1 (highest) to 7 (lowest), for 2018 and 2020 were analyzed for 326 general hospitals (GHs) and 1,419 non-general hospitals (NGHs). The annual revenue growth per nurse generated by changing inpatient nursing care fee schedules and newly introducing night shift nursing fees were estimated. Results: Grade 1 GHs increased from 6.9% in 2018 to 39.6% in 2020, whereas grades 6-7 decreased from 31.8% to 17.6%. NGHs with grades 6-7 decreased from 81.8% to 61.6%. GHs and NGHs with no reported staffing grades decreased from 10.6% to 0% and from 63.2% to 14.8%, respectively. The estimated annual revenue growth per nurse from inpatient nursing care fees resulting from 1-grade improvements in staffing was 1.44~7.26 million Korean won (KRW) and 1.25~9.75 million KRW for GHs and NGHs, respectively, while the results from night shift nursing fees were 2.37~5.54 million KRW and 2.20~5.14 million KRW for GHs and NGHs, respectively. Conclusion: The increased revenues should be utilized to augment nurses’ wages and staffing levels as the guidelines recommend.

적정 간호인력 등급별 입원료 추정 모델을 이용한 간호관리료 차등제 정책개선 재정부담 추계

김성재(Kim Sung jae),김진현(Kim Jin hyun) 한국간호행정학회 2013 간호행정학회지 Vol.19 No.5

The purpose of this study was to identify the major trends in research studies in the Journal of Korean Academy of Nursing Administration from 2010 to 2012. Methods: A review using analysis criteria developed by researchers was done of 132 studies published between 2010 and 2012. Research design, participants, research domain, and keywords were analyzed from the Journal of Korean Nursing Administration. Results: Job satisfaction, stress, organizational commitment, safety, turnover, nursing education, and performance were found to be major keywords. Of the research in the Journal, quantitative methods were used in 93.2% of studies. The major setting and participants were hospitals (58.2%) and nurses (65.5%) respectively. Prevalent analysis methods used were t-test, ANOVA, correlation, regression, chi-square, AMOS, and factor analysis. Major domains in the articles were: controlling, directing, staffing, nursing management education, and professionalism & legal principles. Conclusion: Through this study, the research trends in nursing administration were identified, but there is a need to include more of the following topics in future research: new concepts in nursing policy, enhanced deliberations of IRB, rationalization of the effects in sample size calculations, theoretical development of planning and organizing, and development of interventions for management support of the nursing management process.

입원환자 간호관리료 차등제 변화에 따른 간호사 직무만족, 환자만족도 및 직접간호시간 비교

김세정,이자인,이윤미,Kim, Sea Joung,Lee, Ja Yin,Lee, Yun Mi 한국중환자간호학회 2017 중환자간호학회지 Vol.10 No.3

Purpose : This study aimed to identify nurses' job satisfaction, patients' satisfaction, and direct nursing time according to the change in grade of nursing management fee. Methods : Descriptive design was used in this study. Nurses (n = 200) and patients (n = 200) were recruited from one university hospital in Busan. Four aspects were measured: direct nursing time, overtime, nurses' job satisfaction, and patients' satisfaction. Data were analyzed using descriptive statistics, ${\chi}^2-tests$, and t-tests. Results : There was a significant difference in patient satisfaction (t = -2.09, p = .038) and direct nursing time (t = -4.77, p < .001) when the nurse staffing grade was changed from the level two to the level one. Conclusion : The findings from this study showed that a higher nurse-to-patient ratio can provide a greater amount of direct nursing time for individual patients and increase patient satisfaction.

간호관리료 차등제 도입의 효과 평가

박보현,서수경 한국간호과학회 2012 한국간호과학회 학술대회 Vol.2012 No.10

종합병원 일반병동 간호행위의 활동기준원가분석

윤호순,김진현 한국간호과학회 간호행정학회 2013 간호행정학회지 Vol.19 No.4

Purpose: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. Methods: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. Results: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. Conclusion: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

입원환자 간호관리료 차등제 도입이후 간호사 확보수준의 변화

조성현,전경자,김윤미,박보현 대한간호학회 간호행정학회 2008 간호행정학회지 Vol.14 No.2

Purpose: To examine the changes in nurse staffing in hospitals after implementing the policy of differentiating inpatient nursing fees by staffing grades. Method: The study sample included 43 tertiary hospitals, 185 general hospitals, and 282 non-general hospitals that were operating in both 1999 and 2008. Nurse staffing grade was categorized from Grade 1 (highest) to 6 (lowest) in 1999 or Grade 7 in 2008, based on the nurse-to-bed ratio. Results: Tertiary hospitals at Grade 3 and Grade 4 accounted for 49% and 35%, respectively, in 2008, whereas 63% were Grade 6 in 1999. General hospitals at Grade 6 decreased from 87% to 48%. In non-general hospitals, little change was found in the staffing distribution, in that 92% still remained in Grade 6 or 7 in 2008. Forty tertiary hospitals (93%) and 45% of general hospitals improved their staffing grades, while only 7% of non-general hospitals did. Greater likelihood of improvement in staffing grades was found in general hospitals located in metropolitan areas or having 250 or more beds. Conclusion: Elaboration of the financial incentive system is needed to increase the policy impact on staffing improvement.

환자에게 제공된 실제 간호사 배치수준에 근거한 일반병동 간호관리료 산정방안

조성현(Cho, Sung-Hyun),김진현(Kim, Jinhyun),성지영(Seong, Jiyeong),이지윤(Lee, Ji-Yun) 한국간호행정학회 2023 간호행정학회지 Vol.29 No.5

Purpose: This study aims to propose revised inpatient nursing fee schedules that address three discrepancies between actual nurse staffing levels in general wards and the corresponding patient payment structures. Methods: A total of 45 tertiary hospitals, 329 general hospitals, and 1,379 hospitals from publicly released data for 2021~2022 were analyzed. This analysis focused on three primary discrepancies between (1) the staffing grades under which patients were hospitalized and the corresponding grades for which they were charged; (2) the staffing grades determined by bed-to-nurse and patient-to-nurse criteria; and (3) the current differentiation rates of nursing fees and the expected differentiation rates based on the number of nurses required for each grade. Results: The first discrepancy occurred in 8.9% of tertiary hospitals, 21.0% of general hospitals, and 26.0% of hospitals. The bed-to-nurse and patient-to-nurse grades differed by 2.23 and 2.29 grades on average in general hospitals and hospitals, respectively. The current differentiation rates were higher than the expected differentiation rates. New nursing fee schedules were suggested to resolve those discrepancies. Conclusion: Nursing fees should be charged to reflect the staffing levels under which patients were cared for and proportionate to the number of nurses required to provide the corresponding staffing levels.

경영수지분석을 통한 종합병원의 간호관리료 차등지급제 개선방안

김성재(Kim, Sungjae),김진현(Kim, Jinhyun) 한국간호과학회 2012 Journal of Korean Academy of Nursing Vol.42 No.3