Chinese reliance on contract nurses affecting morale, patient satisfaction

China's aging population has put a lot of stress on its healthcare system, which is increasingly relying on contract nurses, leading to lower patient care and worker satisfaction.

By Ananth Baliga

NEW YORK, Jan. 29 (UPI) -- China's reliance on lower-paid, contract nurses is causing a high level of dissatisfaction among patients and compromising patient care.

Economic and health reforms have caused a shift from traditional nursing jobs, called bianzhi or “iron rice bowl” positions, to contracted nurses. The bianzhi were higher paying, lifelong jobs, where as nurses on contract have limited job security and fewer benefits.


The survey of 181 hospitals across China by Columbia University's School of Nursing suggests that contract nurses had high levels of dissatisfaction with the pay inequality as compared to the bianzhi nurses and also were less likely to be recommended by patients. Hospitals with a disproportionate number of contract nurses had lower customer satisfaction ratings and lower quality care.

“For the best patient outcomes, we really need to have equal pay for equal work,” said Jingjing Shang, associate professor at Columbia University. “The low rate of job satisfaction among contract nurses puts patients at risk.”

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China already has in place regulations that ask hospitals to eliminate this two-tier pay system for nurses, but they aren't mandatory. The average utilization of contract nurses is 51 percent, with some hospitals having only bianzhi nurses, while others had mostly contracted nurses.


The study, published in the journal Human Resources for Health, also found that contract nurses were more likely to be young males, who were unmarried or did not have children, and lacked a formal nursing degree.

"China urgently needs to address the inequalities in nursing compensation to stabilize the nurse workforce and improve the quality of care in hospitals,” Shang said.

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[Columbia University] [Human Resources for Health]

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