Does the number of people managing chronic diseases count as nurse workload

Based on the current actual implementation of domestic medical institutions at all levels, there is no nationwide rigid rule on whether the number of people managed by chronic diseases should be included in the nurse workload. It all depends on the performance accounting rules of the institution where it is located, and the differences can vary greatly in different places.

When I was rotating at the community health service center two years ago, the policy of the center on the next street was very flexible. It directly converted the number of contracted chronic disease patients for standardized management and follow-up compliance rate into workload: 10 stable patients with hypertension and diabetes can be worth a half-day outpatient visit. At that time, if the person in charge was a disabled elderly person with chronic disease who needed to visit their home to measure blood sugar and adjust medicines, the equivalent amount of one could cover three regular follow-up patients. The nurses there were rushing to take over chronic disease management work, and many people took their breaks to take the health management certificate exam, just to be able to accept more places for chronic disease management with complex needs.

But the situation is completely different in another place. In a second-class hospital I stayed in before, chronic disease management was included in the "extra tasks" of the public health line and was not counted as the core performance of clinical nurses. Even if you take half an hour after get off work to provide care to the coronary heart disease department in charge Patients made follow-up calls and compiled medication records for the entire year. At most, they only mentioned a few words during the performance evaluation at the end of the year. They would not pay a penny more for performance. At that time, every time the pediatric department assigned chronic disease management tasks, the director had to do ideological work one by one, and no one was willing to take it.

In fact, the core of the controversy is, to put it bluntly, how to calculate the value of chronic disease management. The accounting logic of many hospitals is that chronic disease management does not generate direct diagnosis and treatment charges and should not occupy the accounting quota of clinical workload; but nurses who have actually done this work know that if the chronic disease patients in the jurisdiction are properly managed, In fact, we can reduce the number of hospitalizations due to acute attacks in a year. Whether it saves patients medical expenses or controls medical insurance expenses, it is a real benefit. Not to mention that many elderly patients with chronic diseases have to visit their homes for follow-up visits. It is common to be out of breath after climbing the fifth or sixth floor. Doing work does not count as workload, and everyone feels aggrieved.

Fortunately, many places have adjusted their policies in the past two years. Some cities in Zhejiang and Guangdong have issued clear guidance, requiring indicators such as the number of people under standardized management of chronic diseases and the follow-up compliance rate to be converted into nurses' performance workload based on weight. Maybe in a few years, there will be more unified standards for this matter, which is always good news for our front-line nurses.