The long-standing issue of nursing shortages, which is also linked to the issue of emergency room (ER) overcrowding, has returned to the spotlight in the past few weeks, with healthcare providers nationwide pleading for help to alleviate the problem.
A case revealed by a nurse on social media on Feb. 21 in which a patient could not be accommodated at a large hospital in southern Taiwan and so had to be transferred to a hospital in Yunlin County, where he died on the same day, particularly caught local media attention and aroused public concern.
Physicians of the Taiwan Society of Emergency Medicine have said in a statement that the seriousness of the issue is “unprecedented,” adding that the root cause is insufficient hospital capacity, likely due to a shortage of nurses, which forces hospitals to close off beds, exacerbating the problem of “boarding” — patients admitted to the ER being put on hold, often in hallways, while they wait for a bed.
The Ministry of Health and Welfare last month held three emergency meetings over the ER overcrowding issue, announcing three short-term strategies and two medium-to-long-term reforms to address the problem. However, the ministry has faced a backlash from doctors and nurses saying its measures are impractical and fail to address the immediate problem.
The three strategies are asking medical centers to readjust the proportion of inpatient and ER beds, improving mechanisms for transferring patients between hospitals and encouraging people to get the right level of medical care based on how serious their condition is.
The two reforms are improving nursing personnel preparedness and encouraging hospitals to increase critical care services, as well as readjusting National Health Insurance payments.
The ministry on Monday last week said it is mulling establishing new nurse-patient ratio standards and bonuses for nurses working three shifts in ERs.
The NHI Administration on Friday also announced plans to raise an additional NT$4 billion (US$121.8 million) annually by increasing consultation and nursing care payments in ERs, and fees for high-severity emergency response hospitals to address the ER overcrowding problem.
As part of the plans, hospitals would be required to meet certain standards to receive the increased payments, including increasing nurses’ salaries and reducing impatient boarding.
However, the announcements have received a lukewarm response. For example, a few doctors in hospital management positions have said that the nursing shortage is not due to a decreasing number of registered nurses, as numbers have been growing, but rather due to nurses being less willing to work in hospitals than clinics, nursing facilities and in the private sector, where work conditions are perceived as less stressful and better paid.
Some have expressed support for the administration’s proposed payment plans, as they would provide incentives for doctors and nurses to work in ERs and for hospitals to allocate more personnel and resources to ERs.
However, some have also said the government must produce mechanisms to better regulate the health system to prevent medical centers from being filled up with people with just mild illnesses.
Others, including Taiwan Nursing and Medical Industries Union consultant Chen Yu-feng (陳玉鳳), have expressed concern that wage increases for nurses do not address the problem of ERs being a high-stress working environment. While the ministry has promised to put nurse-patient ratio standards into law, it has yet to do so.
Some doctors have praised the ministry’s quick response to the nursing shortage and overcrowding problem as “heading in the right direction.” However, it remains to be seen how the measures would be implemented and whether they would be effective.
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