임상전담간호사의 역할 효과성

Abstract

1. Introduction Advanced practice registered nurses are professional medical support nurses who perform tasks under the delegation of an attending physician and also play a variety of roles according to the needs of their clinical departments. Recently, the number of advanced practice registered nurses has increased rapidly due to clinical environment changes, such as the application of doctor's special laws, including a minimum of three years in an internal medicine specialization, at least three years in a surgery specialization, and the avoidance of support. The importance of advanced practice registered nurses is increasing due to their various roles in the medical field. As the importance of these roles increases, an evaluation of the role effectiveness of advanced practice registered nurses should also be required. Therefore, this study examined the general, professional, and psychological characteristics; organizational factors, such as the practice environment; the role and the role enactment; and the performance outcomes of advanced practice registered nurses. 2. Objective The purpose of this study was to identify the general, professional, and psychological characteristics of advanced practice registered nurses, and practice environment, which is an organizational factor, along with the role, role enactment, and performance outcomes of these nurses. In addition, these factors were analyzed to determine how they affect advance practice nurses’ work performance. 3. Theoretical framework Sidani and Irvine (1999) suggested a conceptual framework for evaluating the role of nurse practitioners working in hospitals. A conceptual framework consists of Structure, Process, Outcome. The three sub-factors of their proposed structure were the general, professional, and psychological characteristics of nurses, such as experience, academic background, professional nursing certification, clinical department, primary workplace, job satisfaction, turnover intention, and burnout. Patient factors included age, diagnosis, hospitalization route, accompanying diseases, surgeries, primary diseases, and treatment severity. The organizational factors were the practice environment such as professional visibility, relationship with administrators, relationship with medical staff, and independent behavior. Process means the role and role enactment of advanced practice registered nurses. The advanced practice registered nurse has a role in professional practice, consultation, education, research, and professional activities and acts in ways to extend both nursing and physician services. Outcome means the satisfaction and financial performance and is measured by work performance. The work performance index involves patient satisfaction, the satisfaction of neighboring departments, the patient length of stay, the discharge prescription prepared the day before discharge, and the number of treatments. 4. Research method 1) Research design The participants in this study are advanced practice registered nurses who work at two superior general hospitals with more than 2,000 beds and more than 800 beds and one general hospital with more than 400 beds in Seoul and Gyeonggi. This study is based on the general, professional, and psychological characteristics, the organizational factors, the roles, the role enactments, and the performance outcomes of advanced practice registered nurses. This was a descriptive research study that analyzed factors that influenced the nurses’ work performance using their roles and role enactments along with organizational factors, such as the nursing work environment. 2) Measurement scale ① Psychological characteristics of advanced practice registered nurses Job satisfaction The job satisfaction measurement tool was the same tool used in the study of Sang-han Kim (2017) that was developed by Steers (1984). This tool includes five items and records responses using a Likert-type scale. The higher the score on the 5-point Likert scale, the higher the job satisfaction. The reliability of this measure showed a Cronbach’s α = .83 in Sang-han Kim study and a Cronbach’s α = .84 in the present study. Turnover intention The tool for measuring turnover intention was developed by Mobley (1979) and then modified and supplemented by Ham Jeong-hwa (2013). Thirteen total items are included. The higher the score on the 5-point Likert-type scale, the higher the degree of turnover intention among respondents. The reliability showed a Cronbach’s α = .89 in Jeonghwa Ham’s (2013) study and a Cronbach’s α = .93 in the present study. Burnout The Korean version of the Maslach Burnout Inventory developed by Maslach and Jackson (1981) was used after obtaining permission from the tool developer. Burnout was assessed using nine questions that were scored from 1 point to 5 points each. The higher the score, the higher the degree of burnout. At the time of development, the reliability of the tool had a Cronbach’s α = .76; in the present study, the Cronbach’s α = .88. ② Organizational factors Environment measurement scale The NP-PCOCQ developed by Poghosyan et al. (2013) was used to measure the working environment of a nurse in charge of advanced practice registered nurses in Korea. The tool consists of 29 total questions: 4 that assess professional visibility, 9 that involve the relationship with administrators, 7 that explore the relationship with physicians, and 9 that deal with independent practice and support items. The higher the score on a 4-point Likert-type scale, the better the working environment. The previous Cronbach’s α of all tools was .93, while that of the present study was Cronbach’s α = .92. ③ Role measurement scale The tool for measuring the role of a professional nurse used in the study of Cho Myung-sook et al. (2011) was applied, modified, and supplemented to assess the role of advanced practice registered nurses in the current study. We divided the role of extended nursing roles, and extended physician duties to differentiate nursing tasks performed by the respondents. To determine how much role nurses play in Advanced practice registered nurses' role, the factors consisted of advanced clinical practice (15 questions), consultation (4 questions), research (3 questions), education and counseling (4 questions), and professional activities (5 questions). To assess the amount of role enactment nurses play in an extended nursing role, the respondents answered questions about advanced clinical practice (8 questions), consultation (2 questions), research (2 questions), education and counseling (3 questions), and professional activities (5 questions). To examine the amount of role enactment nurses play in roles that extended the duties of a physician, questions assessed advanced clinical practice (7 questions), consultation (2 questions), research (1 question), education and counseling (1 question), and professional activities (0 questions). Respondents used a 5-point scale to answer the questions, and points were added up for each response. The higher the total score, the more frequent the role. The reliability had a Cronbach’s α = .90 in the original tool and a Cronbach’s α = .84 in the present study. ④ Outcome measurement scale Patient satisfaction The La Monica-Oberst Patient Satisfaction Scale was developed by La Monica et al. (1986) and translated by Eunjoo Choi et al. (2015); the modified and supplemented tool was revised and supplemented to describe advanced practice registered nurses and included 18 items assessed using a 5-point Likert scale. The higher the total score, the higher the patient satisfaction. The original reliability had a Cronbach’s α = .91, and the present study demonstrated a Cronbach’s α = .94. Coworker satisfaction The coworker satisfaction tool was developed by Lee So-yeon (1996) and used with modifications to assess the role of a professional nurse in the study of Kim Sung-ryul, et. al. (2003). It includes 23 items that are rated using a 5-point Likert-type scale. The higher the total score, the higher the amount of coworker satisfaction. The overall reliability had a Cronbach’s α = .86; doctor satisfaction had a Cronbach’s α = .94 in this study, and nurse satisfaction had a Cronbach’s α = .95. Patient data analysis During the three-month period of the study, data on patients in charge of hospitalized patients at three medical institutions in Seoul and Gyeonggi were collected regarding approved procedures, age, sex, clinical department, accompanying diseases, primary disease, surgeries, treatment severity, and hospitalization routes. Accompanying diseases were classified using the Charlson Comorbidity Index; disease severity and surgical severity were examined using the KDRG(Korean diagnosis related group) version 4.0 (2018), and treatment severity was classified based on whether chemotherapy and radiation therapy were required. Financial outcome Length of stay During the study period, the number of days of the length of stay of the patient was verified and measured in days. Discharge prescription on the day before During the study period, it was determined whether the patient had a discharge prescription plan prepared the previous day. If there was no discharge plan from the previous day, it was recorded as 0; if there was a discharge prescription from the previous day, it was recorded as 1. The number of treatment activities In the patient data, the types of treatments administered by nurses per patient were verified, and the number of treatments by patient was also recorded. 3) Data collection The participants of the study were advanced practice registered nurses working at two superior general hospitals with 2000 beds or more and with 800 beds or more, and at one general hospital with 400 or more beds in the Seoul and Gyeonggi areas. This study was conducted from May–September 2020. The researcher who manages the participants did not participate in the research survey to protect the participants’ privacy. The inventory was distributed by researchers to those who understood the purpose of the study and who voluntarily provided informed consent. In addition, a satisfaction questionnaire was administered after the study’s completion by a researcher who explained the purpose of the study both to the participants and also to the patients, physicians, and nurses. In-office research-related bulletin posters were produced and posted, and questionnaires were provided to those who voluntarily signed an informed consent form after the researcher explained that there was no disadvantage if they discontinued their participation. The performance outcome was checked using surveys and medical records. The medical records were submitted to the medical records department at the hospitals for research-related matters, and the data were used after obtaining approval. 4) Data analysis For work performance, the factors influencing financial outcome were identified using a multi-level regression analysis that examined the length of stay, a multi-level logistic regression analysis for the presence of a discharge prescription the day before discharge, and a multi-level Poisson regression analysis for the number of treatment activities. 5. Research Results 1) General, professional, and psychological characteristics of advanced practice registered nurses Among the general characteristics of advanced practice registered nurses, the average age was 34.43 ± 5.51 years, with most nurses being in their 30s. College graduates accounted for the largest number of advanced practice registered nurses at 77 (59.2%), and 53 (40.8%) had a master’s degree or higher. The advanced practice registered nurses by department were as follows: 20 in general surgery (15.4%), 17 in neurosurgery (13.1%), and 12 in cardiology (9.2%). Regarding their type of work, 87 (66.9%) worked in a ward, 13 (10%) assisted in outpatient areas, and 30 (23.1%) performed both ward and outpatient work. Of the total nurses, 93 (71.6%) worked overtime hours during the study period. Job satisfaction was rated as 3.69 ± 0.57. The turnover intention was rated as 2.90 ± 0.73. Burnout was rated as 2.97 ± 0.71. 2) Organizational factors For factors affecting the working environment of the advanced practice registered nurses, professional visibility was rated as 2.67 ± 0.58 points. The relationship with administrators was given 2.29 ± 0.52 points, while the relationship with physicians scored 3.11 ± 0.41 points. Finally, the availability of independent practice and support was given 2.80 ± 0.38 points. 3) Role of advanced practice registered nurses Among the roles of advanced practice registered nurses by area, advanced clinical practice scored the highest with 4.06 ± 0.68 points, followed by education and counseling at 3.59 ± 0.72 points, consultation and referral at 3.52 ± 1.07 points, research at 2.56 ± 1.12 points, and professional activities at 2.45 ± 0.99 points. 4) Outcome Satisfaction was rated as 4.71 ± 0.37 among patients, 4.21 ± 0.59 among doctors, and 4.06 ± 0.62 among nurses. The length of stay was 6.50 ± 6.91 days. The presence of a discharge prescription on the day before discharge was 0.61 ± 0.48, and the number of treatment activities was 0.61 ± 0.57. 5) Factors influencing outcome (financial outcome) General characteristics, job characteristics, and psychological factors Among the factors of advanced practice registered nurses, the patient length of stay was shorter in those with a professional master’s degree (β = -0.042, p = .050) than it was for nurses with a bachelor’s degree, and the presence of a discharge prescription on the day before discharge was high with an odds ratio of 1.99 (95% CI: 1.05-2.78). For nurses who completed general master’s programs, the number of treatment activities had an RR of 1.28 (95% CI: 1.06-1.70). For nurses who completed a professional master’s course after a bachelor’s program, the number of treatments had an RR of 1.08 (95% CI: 1.01-1.38). In regards to experience, having a discharge prescription prepared the day before discharge was higher in nurses with 3–7 years at their current position compared to those who had worked just 1 year (Odds 1.73 (95% CI: 1.09-2.74)). When nurses with 7 years’ experience were compared with those with just 1 year on the job, the Odds was 1.24 (95% CI: 1.08-1.49). The average length of stay was longer in the internal medicine department than in the surgical department (β = 0.266, p = .000), and there were fewer treatment activities in the internal medicine department with an RR of 0.71 (95% CI: 0.59-0.85). The length of stay was shorter for outpatient and ward nurses than for nurses who worked in a ward (β = -0.224 p = .004), and the odds of having a discharge plan the day before discharge were 1.37 (95% CI: 1.02-2.05) for nurses who worked both in a ward and in an outpatient setting than for ward nurses. Practice environment Having a better relationship with physicians was associated with a shorter length of stay (β = -0.221, p = .020) and also with a higher number of treatment activities (RR: 1.68 (95% CI: 1.54-1.86)). Nurses who reported a better environment for independent behavior and support also were associated with a higher number of treatment activities (RR: 1.33 (95% CI: 1.05-1.68)). Roles Among nursing roles, the greater the consultation, the shorter the length of stay (β = -0.268, p = .009). The greater the amount of advanced clinical practice responsibilities, the higher the RR 1.06 (95% CI: 1.00-1.31) for the number of treatment activities. 6. Discussion This study aimed to provide basic data on the role, role enactment, and outcome of advanced practice registered nurses through an analysis of their work performance and influencing factors, as well as the proper role establishment and quality of their work. In an academic background comparison study of professional support personnel at medical institutions nationwide, advanced practice registered nurses notified general nurses of basic qualifications at the time of selection, received documented support, and were finally selected through interviews. However, a professional nurse’s license is currently not required due to the absence of the qualification policy, and it is still insufficient compared to NP and PA roles in the U.S., which require master’s degrees and professional certifications (Kwak Chan-young, Park Jin-ah, 2014). Each medical institution should require basic qualification regulations through an official selection process. Furthermore, it is urgent to establish a national qualification standard policy that allows professional nurses to play a role only when they obtain professional nursing certifications. Internal medicine departments accounted for a large percentage of the participants in this study compared with other similar studies. This means that the proportion of these nurses is gradually increasing due to the application of the three-year internal medicine major. Because a system of advanced practice registered nurses in surgical departments has already been tried , a clear analysis of the role of advanced practice registered nurses in the internal medicine department should be carried out to prevent trials and errors in the internal medicine department. Currently, the special law on majors in certain departments or the application of a three-year medical major is increasing the rate of change of nurses to shift or on-call work rather than regular hours, and many advanced practice registered nurses still work overtime. This practice causes many advanced practice registered nurses to experience exhaustion due to the burden of overtime (Kim Yoo-jin, et al., 2019) and also requires changes in their work to compensate for the lack of medical majors. Some nurses leave advanced practice registered nursing due to a reduction in job satisfaction (choi Hee-sun, 2012). To prevent this behavior, the current practice should be changed through an agreement with advanced practice registered nurses rather than an appropriate level of working hours and coercion depending on the situation. Advanced clinical practice, education, and counseling are recognized as major roles of nursing professionals (Lee Hye-ran, 2017). An investigation into the perception of advanced practice registered nurses revealed that the medical team is highly satisfied with and recognizes the importance of this role (Kim min-ji, 2015). Recognizing the importance of the role and identifying the exact duties required by the roles will be necessary to ensure better performance of the role, along with individual efforts to ensure competence. However, only 68.3% of medical institutions have standardized work guidelines (Kim Min-young et al., 2017), so it is urgent to establish standards and work categories at medical institutions to revitalize the role of advanced practice registered nurses. Furthermore, as has been done with NPs in the US, it will be necessary to institutionalize laws on the roles and the role enactments of these professionals. A 10-year survey of publications on NPs and PAs revealed that many studies have linked the role and performance of professional nurses (Ruth M. Kleinpell et al., 2019). This is seen as an opportunity to demonstrate to patients and medical staff the importance of the role by presenting high-quality nursing and cost-effective aspects and also to highlight the importance of the role and performance-related studies. This study is believed to have been difficult to influence patient satisfaction because of advanced practice registered nurses’ various, unclear roles. Prior study on the satisfaction of patients and medical staff with professional nurses, such as the work of Kim Soo-hyun (2014), has found patient satisfaction with professional nurses to be low. Advanced practice registered nurses should recognize that they are professional nursing personnel and should be responsible for engaging in their work and striving for better patient satisfaction. In terms of doctor and nurse satisfaction, surgical department advanced practice registered nurses represented the majority. Medical staff members were highly satisfied with the schedule, care of surgery, wound management, simple drug administration, testing, and discharge prescription support of nurses (Kim Sung-ryul, 2013). The length of stay was shorter in advance practice registered nurses who had completed a professional master-level course than for traditional college graduates. In addition, It was higher in those with a professional master’s course for preparing a discharge plan on the previous day. In those with a general master-level education or a professional master’s course, the number of treatment activities had respectively, compared with those who only had completed an undergraduate degree. In a study on the importance, satisfaction, and contribution of professional nurses, Cho Myoung-sook (2011) reported that professional nurse have completed a professional master’s program and obtained professional nursing certificates as part of their efforts to ensure patient care and nursing continuity. Therefore, professional nurses have the opportunity to increase their professional practical skills through professional nursing programs and their own personal efforts to perform better roles as advanced practice registered nurses with the goal of a more positive performance. In addition, professional competence, which is the ability to solve various clinical situations obtained through professional training courses, allows nurses to quickly make decisions in patient care, enabling autonomous intervention to meet patient needs. The competence of advanced practice registered nurses is a important factor for the growth of advanced practice registered nurses and is necessary for a safe medical environment. Advanced practice registered nurses themselves should not hesitate to make personal efforts to increase their professional capabilities and participate in hospital standards and policy directions for patient care to cope with changes in the medical community due to the current three-year medical majors and internship issues (Park Boo-yeon et al., 2012). In the case of advanced practice registered nurse experience, It was higher for creating a discharge prescription on the day before discharge for advanced practice registered nurses with 3–7 years’ experience compared with those who had less than 1 year of work experience. In addition, It was higher for having a discharge prescription on the day before discharge in advanced practice registered nurses with 7 years or more years of experience compared with those who had less than 1 year. The number of treatment activities for advanced practice registered nurses with 3–7 years and 7 years or longer of experience were high respectively. Minji Kim et al. (2015) investigated the perception of dedicated nurses by medical professionals and found that advanced practice registered nurses with at least five years of experience were more trusted than those with less experience. The competency of advanced practice registered nurses increases through interactions with patients and also by solving problems based on clinical field experience. It can be seen that policy support is needed to maintain experienced nurses. The hospitalization period was longer in the internal medicine department than in the surgical department, and the number of treatment activities in the internal medicine department was lower. The lack of support from the degree program occurred first in the surgical department, so the demand to better define the role of advanced practice registered nurses is high. Currently, the need is gradually increasing with the application of a three-year program in internal medicine majors, but it is still a work in progress, and it will take some time for the work performance to be seen. In terms of performance, the hospitalization period was shorter for joint ward and outpatient work than for ward work alone, and It was higher for a discharge prescription the day before in the ward and outpatient work group than for nurses who worked in the wards alone. In a study on the importance, satisfaction, and contribution of the role of a professional nurse, there was an advantage compared to general nurses in communication with medical staff, which supports rapid problem solving. Advanced practice registered nurses who are in charge of both the ward and the outpatient clinic demonstrated similar results in this study. It takes a shorter amount of time to identify, report, and resolve the patient’s problem by contacting the nurse who consulted with the patient. It is believed that advanced nurses played a positive role on the length of hospital stay and whether or not to prescribe discharge on the previous day by accessing it with the knowledge that was known. As for practice environment, the better the relationship with the medical staff, the shorter the length of stay (β = -0.221, p = .020) and also the better the environment for independent actions and support, The number of treatment activities was high with an RR of 1.33 (range: 1.05-1.68). In a study by Kang Young-ah et al. on the experience of medical professionals working with professional nurses, it was suggested that the environment is associated with an improvement in the quality of the work performance. It was in agreement with our results that positive work performance is observed when the relationship between medical staff members is good. As for the role of the advanced practice registered nurse, the length of hospitalization was shorter as the number of consulting activities increased. The number of treatment activities was high as the number of consulting activities increased. In a study on the satisfaction of medical staff members with the role of professional oncology nurses (Kim Soo-hyun, 2014), advanced clinical practice and consultation influenced satisfaction and the high importance of recognition for both neighboring medical staff. This result is consistent with the report that professional practices (such as intervention activities and consulting with medical staff) have a positive result on patient condition (Lisa C. Lindley, Melanie J. Cozad, 2017). The consultation request means that the patient’s overall problem is likely to be solved quickly through communication with the medical team, which affects the length of stay. Advanced clinical practice requires a higher level of practice directly performed by advanced practice registered nurses, such as education and treatment, which means that the number of treatment activities can vary depending on competence. Ultimately, Lorna MacLellan et al. (2015) explained that professional nursing requires autonomous behavior, experienced practice, confidence, and the competence to play a successful role on the medical care team. It is not the right path for a professional nurse to give up on her job as a professional nurse. In order for current advanced practice registered nurses to grow into successful professional nurses in the future, the effectiveness of their roles, along with the evaluation of the exact roles and role enactment of advanced practice registered nurses must be analyzed, influential factors identified, disability factors. This is not sufficient only by the personal efforts of advanced practice registered nurses and requires systematic and policy institutional support. 7. Conclusion This study evaluated the role effectiveness of advanced practice registered nurses and the role enactment through factors such as patients, general, professional, and psychological characteristics of advanced practice registered nurses, and organizational factors. This study was a descriptive investigation study that examined factors that influence role effectiveness. A formal evaluation of the role effectiveness of advanced practice registered nurses has been proposed for use in the clinical field and suggests the need for hospital-level manpower management and policy improvement in qualifications, selection, the training of experienced nurses, and nursing regular education programs. Individual, organizational, and institutional efforts are required to establish work protocols and guidelines for each department, and it is suggested to establish an operating committee for advanced practice registered nurses at each hospital for periodic and practical discussions and to institutionalize a national legal system.

임상전담간호사는 주치의의 위임 하에 업무를 수행하고 있는 전문진료지원인력으로 임상과별 요구에 따라 다양한 역할을 수행한다. 최근 의료 현장에서는 전공의 특별법 적용, 내과 전공의 3년제, 외과 전공의 3년제 등과 일부 임상과의 전공의 지원 기피 현상으로 임상전담간호사가 급격히 증가하고, 업무와 역할의 중요성이 높아지고 있다. 임상전담간호사의 역할이 단순한 전공의 대체 업무 수행 보다는 환자에게 제공되는 질 높은 간호 업무의 성과로 이어질 수 있도록 역할의 효과성을 평가하는 것이 필요하다. 이에 본 연구는 임상전담 간호사의 일반적, 직무적, 심리적 특성, 조직적 요인과 임상전담간호사의 역할 및 업무 범주를 파악하고, 업무 성과를 확인하며 이에 미치는 영향 요인들을 분석하여, 임상전담간호사의 역할 효과성을 평가하였다. Sidani S & Irvan D(1999) “A conceptual framework for evaluating the nurse practitioner role in acute care settings” 을 바탕으로 “임상전담간호사의 역할 효과성 개념적 기틀” 을 적용하여 임상전담간호사 요인, 조직적 요인, 역할 및 업무 범주, 업무 성과 영향 요인을 분석하였다. 업무 성과는 만족도와 재무적 성과를 의미하며, 재무적 성과는 재원기간, 전일 퇴원 처방 여부, 처치 수가 행위 건수를 말한다. 자료 수집은 2020년 5월부터 9월까지 진행하였고, 연구 대상은 임상전담 간호사 130명, 만족도 대상은 환자 132명, 의사 129명, 간호사 139명이며, 연구기간 동안 입원환자 16,087명의 의무기록을 분석하였다. 연구 결과는 다음과 같다. 첫째, 임상전담간호사 평균 연령은 34.43±5.51세로 30대가 가장 많고, 학력은 대졸이 77명(59.2%)으로 다수를 차지하였으며, 석사 이상이 53명(40.8%)으로 나타났다. 전문간호사 자격증 취득자는 30명(23.0%)이고, 외과계가 78명(60%)이며, 병동업무는 87명(66.9%)이 담당하는 것으로 나타났다. 정규시간 근무가 85명(65.4%)이며, 시간외 근로를 하는 경우가 93명(71.6%)으로 나타났다. 임상전담간호사의 직무 만족도는 3.69±0.57점, 이직의도는 2.97±0.71점, 소진은 2.90±0.73점으로 나타났으며, 임상전담간호사의 조직적 요인인 전문가적 가시성 영역 2.67±0.58점, 행정가와의 관계 2.29±0.52점, 의료진과의 관계 3.11±0.41점, 독립적 행위 및 지원이 2.80±0.38점으로 나타났다. 임상전담간호사의 역할은 전문가적 실무 4.06±0.68점, 교육 및 상담 3.59±0.72점, 자문 및 의뢰 3.52±1.07점, 연구 2.56±1.12점, 전문활동 2.45±0.99점으로 나타났으며, 업무 범주 중 간호 확장업무는 3.19±0.70점, 의사 지원업무는 2.87±0.54점으로 나타났다. 업무 성과 중 만족도는 환자 만족도 4.71±0.37점, 의사 만족도 4.21±0.59점, 간호사 만족도 4.06±0.62점으로 나타났다. 둘째, 재무적 성과인 재원기간의 영향 요인으로 학력에 있어 대졸보다 전문간호사 석사(재학포함)가 재원기간이 짧았으며(β=-0.042, p=.050), 외과계보다 내과계가 재원 기간이 더 긴 것으로 나타났다(β=0.266, p=.000). 담당업무에 있어 병동 담당보다 병동과 외래를 함께 담당하는 경우가 재원기간이 짧았으며(β=-0.224 p=.004), 조직적 요인 중 의료진과의 관계가 좋을수록 재원기간이 짧았고(β=-0.221, p=.020), 역할 중 자문의뢰 활동이 많을수록 재원기간이 짧은 것으로 나타났다(β=-0.268, p=.009). 셋째, 재무적 성과인 전일 퇴원 처방 여부 영향 요인은 학력으로 대졸보다 전문 간호사석사(재학포함)가 odds 1.99(95% CI 1.05-2.78) 높았으며, 임상전담간호사 경력 1년 미만 보다 3년에서 7년 미만이 odds 1.73(95% CI 1.09-2.74) 높았고, 7년 이상이 odds 1.24(95% CI 1.08-1.49) 높았다. 담당업무에 있어 병동 담당보다 병동과 외래를 함께 담당하는 임상전담간호사가 odds 1.37(95% CI 1.02-2.05) 높은 것으로 나타났다. 넷째, 재무적 성과인 처치 수가 행위 건수에 대한 영향 요인으로 학력은 처치 수가 행위 건수가 대졸보다 일반대학원석사(재학포함) RR 1.28(95% CI 1.06-1.70), 전문간호사석사(재학포함)가 RR 1.08(95% CI 1.01-1.38) 높은 것으로 나타났다. 임상전담간호사 경력은 1년 미만 보다 3년에서 7년 미만이 RR 1.06(95% CI 1.00-1.22), 7년 이상이 RR 1.30(95% CI 1.04-1.63) 높은 것으로 나타났으며, 외과계보다 내과계가 RR 0.71(95% CI 0.59-0.85) 낮은 것으로 나타났다. 조직적 요인 중 의료진과의 관계가 좋을수록 RR 1.68(95% CI 1.54-1.86) 높은 것으로 나타났으며, 독립적 행위 및 지원의 환경이 좋을수록 RR 1.33(95% CI 1.05-1.68) 높은 것으로 나타났고, 역할 중 전문가적 실무 역할이 많을수록 RR 1.06(95% CI 1.00-1.31) 높은 것으로 나타났다. 결론적으로 임상전담간호사의 역할 및 업무 범주의 올바른 확립과 전문가로 성장하기 위해서는 객관적인 업무 성과 지표를 바탕으로 임상전담간호사의 역할 효과성이 평가되어야 한다. 본 연구에서는 “임상전담간호사의 역할 효과성 개념적 기틀”을 임상 현장에 적용하여, 임상전담 간호사의 역할 효과성을 평가하였다. 제언으로는 임상전담간호사의 정규 교육 프로그램 마련 및 전문간호사석사 자격증 취득자 활용과 자격 및 선발, 경력자 유지에 대한 병원 차원의 인력 관리, 병원내 표준화된 업무 프로토콜과 지침 마련을 위한 개인적, 조직적, 제도적 노력의 필요성과 지속적이며 실질적인 논의를 위한 병원별 임상전담간호사 운영위원회 개설과 국가차원에서의 법적 제도화를 제언한다.