LegCo Panel on Health Services
Progress Report on Nursing Manpower
This paper reports on the progress in addressing the nursing manpower situation in Hospital Authority (HA) hospitals.
2. A report on a review of the nursing manpower situation in the HA was tabled for discussion by the Panel at its January 1997 meeting. The review identified that there are a number of specialties which are under staffing pressure. An additional 580 nurses were initially assessed to be required to relieve the staffing pressure in medical, surgical, psychiatric and critical care areas.
3. The Panel was further informed by HA and the Administration about the intention to provide the additional nurses in phases at subsequent meetings. This is a progress report on the action taken by HA in addressing the nursing manpower situation.
4. HA has made continuous efforts to improve the provision of nursing manpower to meet service needs. The improvement in recruitment and retention of both qualified nurses and learners in the past two years has led to an improved provision of qualified nurses in HA. The increase in number of qualified nurses is an important means to relieve nursing workload and improve the quality of patient care in the long run. The provision of qualified nurses has improved correspondingly in the past two years. The following is a table on the current status of nurses in HA as compared with the end of 1996/97:
|Type of nurse||31/3/97||31/11/98*||Increase
* N.B. figures are based on estimates
5. HA was able to provide about 200 additional nurses during 1997/98 financial year and is planning to achieve the target of 380 additional nurses in 1998/99. The increased provision will be in addition to the 500 nurses per year for existing and new services. The provision of additional nursing manpower will be achieved through a combination of more direct intakes of qualified nurses and learners as well as the projected reduction in turnover rate. The following table illustrates the progress of the nursing manpower situation in 1998/99 as at end November 1998:
|Nurses as at end November 1998*
|(a) Intake of nurses
|Balance = (a) - (b)
* N.B. figures are based on estimates
6. According to the current plan until the end of 1998/99, a further intake of about 585 nurses is expected and the projected turnover is about 300 nurses in the next few months before the end of the financial year. As far as qualified nurses is concerned, a total of 1029 nurses have already graduated this year. A further 450 nurses are expected to graduate in the next few months making up a total of almost 1500 newly graduated nurses for the financial year.
7. The Hospital Authority has also implemented the following measures to improve the nursing manpower situation in hospitals:
a) Creation of a central pool of nurses
Central nursing pools were formed in some hospitals as part of the measures to relieve workload pressure in areas where they are needed. Nurses can be deployed from a central pool to different wards and units as a result of assessment made by local hospital management.
b) Reengineering of nursing work practices and skill mix
There were significant improvements in maximizing nursing manpower utilization in the past few years through re-engineering of work practices and changes in skill mix. Many of the HA hospitals have introduced integrated documentation having nurses, doctors and other health care professionals putting their patients' progress on the same sheet in chronological order. This approach reduces duplication in documentation, enhances communication between health care professionals and reduces nursing documentation work. Some HA hospitals have already commenced the development and utilization of an integrated assessment sheet. This will help further reduce duplication and enhance the appropriateness of information on patient care management. A recent study has revealed that a saving of about 38 minutes per patient can be achieved through the introduction of an integrated approach to patient documentation.
Many hospital wards and units are looking at innovative ways of improving practice and utilization of nursing staff. For examples, nursing staff shift handover has been moved to the patient's bedside rather than the nurses station. This is a more efficient way of shift handover. This can improve communication between nurses and patients, and reduce nursing time in checking patients' conditions during and after the shift handover.
c) Enhancing support for nurses
Business support such as topping-up systems have been introduced in HA hospitals and thus reducing the need for nurses to count and order many items of various ward supply. Previous studies have indicated that Health Care Assistants (HCAs) could relieve nurses of between 10% and 20% of simple patient care duties. The subsequent introduction of HCAs in wards has been well received by nurses and patients. The total number of HCAs was 3820 at the end of November 1998. Many hospitals have also introduced clinic assistants which allows the redistribution of valuable nursing resources from outpatient clinics.
8. In addressing the nursing manpower issues, the Authority has adopted a rational approach. The overall number of qualified nurses has been increased over the years. The Authority will continue with its efforts to improve the effective utilisation of nurses through re-engineering of work practices and enhancement of support systems for nurses in the wards.