중환자실 적정 간호사 배치수준과 간호관리료 차등제 개선 연구
A Study on Appropriate Nurse Staffing Levels in Intensive Care Units and Improvement of the Critical Care Nursing Fee Schedules
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초록
목적: 본 연구의 목적은 상급종합병원과 종합병원 중환자실의 중환자실 간호관리료 차등제 등급과 간호관리료 현황을 확인하고, 전문가의 판단에 근거한 중환자실 적정 간호사 배치수준과 간호관리료 차등제 개정안을 제안하기 위한 것이다. 방법: 2017년∼2022년에 걸쳐 중환자실 간호관리료 차등제 등급과 중환자실 간호관리료 현황을 분석하였다. 중환자실의 실제 간호사 배치수준과 적정 간호사 배치수준을 확인하기 위하여 77명의 간호관리자와 708명의 일반간호사를 대상으로 설문을 시행하였다. 결과: 중환자실 간호관리료 차등제 1등급은 상급종합병원은 2017년 25.6%에서 2022년 92.1%로 증가하였고, 종합병원의 1등급은 2017년 0.8%에서 2022년 28.4%로 증가하였다. 중환자실 실제 간호사 배치수준은 상급종합병원은 1:2.21, 종합병원은 1:2.77로 나타났다. 상급종합병원 중환자실의 적정 간호사 배치수준은 인공호흡기 적용이상 중증도의 환자는 1:1.00, 인공호흡기 적용 미만 중증도의 환자는 1:2.00이었고, 종합병원은 각 1:1.25와 1:2.00이었다. 결론: 중환자실 적정 간호사 배치수준은 1:1.00에서 1:2.00으로 제안하고, 중환자실 간호관리료 차등제 개선안은 1등급(1:1.00)에서 5등급(1:3.00)으로 제안하였다. 등급 기준과 연간근무일수를 충족할 수 있는 최소 간호사수가 만족될 때 중환자실 간호관리료를 지급할 것을 제안하였다. 중환자실 간호관리료 차등제 개선안은 중환자실 간호사 배치수준 향상과 간호근무환경 개선에 기여할 것이다.
Abstract
Purpose: This study attempted to analyze the staffing level and critical care nursing fees of intensive care unitsat tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing leveland critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for thefirst quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted onnursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. Results:Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patientswith more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiaryhospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients withoutany ventilator application in general hospitals, respectively. Conclusion: The appropriate staffing level wassuggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0(Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standardannual working days. It is expected to increase staffing levels and provide a better nursing work environment.
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