????Xinhua News Agency, Nanchang, May 11th (Reporter Gao Haoliang, Wu Zhongyu) "Where did the nurse go?" This is a sentence that is often asked in the ward. There is a fact that cannot be ignored behind this sentence: the "bed-to-nurse ratio" of 1: 0.4 formulated by the state 36 years ago is still difficult to meet the standard.

????The reporter’s investigation found that the rapid growth of nursing demand and the long-term shortage of nursing investment have jointly caused the shortage of nursing staff, which has been aggravated by the emphasis on "medicine" and the neglect of "nursing", frequent incidents of injury to doctors and nurses, and the decrease of nursing students.

????The "bed-to-nurse ratio" that is difficult to reach the standard in 36 years

????Gao Li, a 26-year-old nurse at the Pediatric Heart Disease Treatment Center of Jiangxi Children’s Hospital, worked 15 night shifts in April. Last year, she worked a total of 118 night shifts, which means that she worked night shifts nearly one third of the year. Despite this, when the hospital was admitted to the peak, the number of nursing staff was still very short. More than 1,500 beds in the general wards of the hospital were equipped with less than 500 nurses, and the ratio was far from 1: 0.4.

????In fact, in 1978, the former Ministry of Health’s Principles for Organizing General Hospitals (Trial Draft) stipulated that the ratio of beds to nurses in medical and health institutions should not be less than 1: 0.4. On May 12th, 2008, the State Council promulgated the Nurses’ Regulations, which once again established this standard in legal form. Thirty-six years later, the ratio of beds to nurses in general wards of tertiary hospitals is 1: 0.4, which is still a "reference standard" that is difficult to implement.

????Sun Qingning, vice chairman of Jiangxi Nursing Association, has participated in the investigation of "bed-to-nurse ratio" in hospitals at all levels in Jiangxi Province for many times. She told reporters that at present, the actual "bed-to-nurse ratio" of general wards in major hospitals in Jiangxi is generally difficult to meet the standard. "If you can barely meet the standard according to the bed accounting, it will be difficult to meet the standard after counting the extra bed." According to statistics, the number of beds in Jiangxi Children’s Hospital is more than 1,200, and the daily average number of inpatients in the hospital for five consecutive weeks exceeds 1,700.

????"When nurses are tired of coping with the increasing number of patients, they have no time and energy to communicate further, and patients will think that nurses have a bad service attitude." Wang Xia, director of the nursing department of the First Affiliated Hospital of Nanchang University, told the reporter that the shortage of staff caused nurses to work overtime for a long time, which affected the service quality of the hospital to a certain extent and further aggravated the tension between doctors and patients.

????Xiao Jing (pseudonym), who has submitted a resignation report to the hospital and is ready to leave the nursing post for 10 years on June 1, told reporters that the long-term overwork and further deterioration of the practice environment made her determined to resign and engage in the insurance industry.

????Hu Meiying, deputy to the National People’s Congress and head nurse of the Pediatric Heart Disease Treatment Center of Jiangxi Children’s Hospital, told the reporter that unlike the previous "job-hopping" within the industry, there are signs and trends that nurses leave the nursing industry to varying degrees.

????Paying more attention to "medicine" than "nursing" leads to the shortage of nurses.

????Before 2005, Jiangxi Cancer Hospital only needed to recruit less than 20 new nurses every year. In the past five years, hospitals have recruited nearly 100 people every year, but they are still "not enough" and often face the dilemma of not recruiting people.

????Mao Meiqi, executive director of the Chinese Nursing Association, told reporters that with the improvement of people’s living standards and frequent diseases, people’s requirements for health are not what they used to be. At the same time, the standard of medical insurance financing has been improved year by year, which has released a large number of people’s medical needs, and the "one bed is hard to find" in tertiary hospitals has intensified. Minor ailments and excessive medical treatment have also aggravated the shortage of medical resources. Limited nursing resources can’t meet the rapidly growing medical needs of people at present.

????According to statistics, in 2002, the number of outpatients in medical institutions nationwide was 2.145 billion, and in 2013, this number surged to 7.3 billion. Correspondingly, in 2012, there were 1.85 registered nurses per 1,000 population in China, which was still lower than the standard of 2 nurses per 1,000 population recommended by the World Health Organization.

????"Now the hospital departments implement economic accounting, doctors can directly create economic benefits, but nurses can only increase the input cost of the hospital. From the cost control point of view, the hospital is not willing to add more nurses." The person in charge of the nursing department of a 3A hospital in Jiangxi Province believes that the shortage of nursing staff is also related to the hospital’s long-term emphasis on "medical care" rather than "nursing care". A survey data shows that the nursing charge in China is only about 10% of the nursing cost, which forces hospitals to reduce the number and treatment of nurses to some extent.

????The deterioration of the practice environment and the decrease in the number of students enrolled in the college entrance examination have also led to a lack of successors in the nursing team to some extent. Cheng Ruifeng, vice president of Jiangxi Vocational College of Nursing, who is in charge of enrollment and employment, told reporters that frequent incidents of injury to doctors and nurses have affected the enthusiasm of students and parents to apply for nursing majors. Jiangxi Vocational and Technical College of Nursing was once praised as "Tsinghua Peking University" in higher vocational education by Jiangxi Examinations Institute, and its admission scores were among the highest in similar schools. However, in recent years, because of the sharp drop in the number of students, candidates can be admitted if they basically reach the score line.

????The whole society should form a benign professional identity of nurses

????"Three points of treatment, seven points of care. Nurses spend the longest time with patients and play an immeasurable role in alleviating the contradiction between doctors and patients. " Mao Meiqi believes that in order to stabilize this team, we must first increase investment. On the basis of reaching the standard of "bed-to-nurse ratio" of 1: 0.4, it is possible to achieve a higher level of nursing service.

????Xiong Xiaoyun, director of the nursing department of the Second Affiliated Hospital of Nanchang University, believes that it is necessary to ensure that the ratio of basic bed care is up to standard, and at the same time, it is necessary to change the current situation of emphasizing "medicine" over "care", give nurses more room to realize their self-worth and improve their professional identity.

????According to reports, since 2011, this hospital has implemented a division of labor mechanism in which doctors are responsible for treatment and nurses manage hospital bed resources. The nursing department can use its own advantages to uniformly allocate beds across departments in the hospital, breaking the restrictions of fixed beds in previous departments. "It not only avoids the shortage or idleness of beds caused by uneven drought and flood in departments, but also improves the performance of nurses and mobilizes their work enthusiasm." Xiong Xiaoyun said.

????Hu Meiying believes that the difficulty in implementing graded diagnosis and treatment has also caused the shortage of nurses in some hospitals to some extent. It is not the most effective way to solve the problem of overcrowding in large hospitals by setting different reimbursement ratios, quantitative indicators or limiting referral. The government should strive to strengthen the level and influence of medical services in primary hospitals, so that people can choose to go to primary hospitals voluntarily, so that medical resources can be allocated in a balanced way and used effectively. (