臨床護理人員的護理工作認知、工作環境與離職意願相關因素之探討

摘要護理人員是醫院重要且人數最多的一群，若護理職場長期處於人力不穩定的環境，輕微則影響護理人員的工作表現，嚴重則導致異常事件，影響其照護品質及危害病患的生命安全。因此，早期關注並正視護理人員留任的重要，並使其具有專業優勢及發揮專業所長，促使護理人員對護理工作具有自信及發展，進而提供病患好的照護品質，所以，檢視護理人員的離職與留任相關因素與措施，是刻不容緩的。本研究計畫的研究目的乃在探討臨床護理人員的護理工作認知、工作環境與離職意願之相關因素。採橫斷式相關性研究設計，以非隨機取樣法於南部三家醫院臨床護理人員，以結構式問卷收集資料，共發放700份問卷，回收有效問卷為674份，回收率96.3％，問卷包括基本屬性如人口學資料及工作相關資料、護理工作認知量表、護理工作環境量表等部分。收集到的資料以SPSS for Windows 18.0 套裝軟體進行統計分析，以描述性統計呈現護理人員人口學特性、工作相關因子、護理工作認知、工作環境及離職意願量表分布狀況；以雙變項分析人口學特性、工作相關因子、護理工作認知、工作環境；並以複迴歸探討離職意願的重要決定因子。研究結果發現，研究對象以女性佔97.8%，平均年齡為29.7歲， IV 從事護理工作平均年資為7.05年，工作機構以醫學中心佔58.2 ， 55.2%服務於內外科單位，39.7%服務特殊單位。影響離職意願之相關因子為，有、無配偶、工作單位、工作機構、工作班別、護理工作認知及護理工作環境等。複迴歸分析顯示離職意願之重要決定因子共有八個，依其解釋力由高至低分別為職業認同(16.5%)、組織氣候與工作環境(5.0%)、工作單位(3.1%)、足夠的護理人力與各類資源 (1.7%)、同儕互動(1.1%)、配偶(0.9%)、工作機構(0.8%)及工作班別 (0.8%)，其對離職意願的解釋力為29.1%。本研究結果顯示護理人員的離職相關因素與個人、職業認同及環境有相當的關係，因此，建議醫院管理階層必須關注及正視此問題，除必須提昇護理人員對職業的認同外，更應成立護理單位專業化建立之機制。工作相關因素、護理工作認知及工作環境等變項對離職意願有顯著相關，顯示重視護理人員對職業認同的概念與尋求支持系統的重要性，審視並改善護理工作環境人力與資源的合適性。此外，適當調整各工作單位專業性的工作負擔，正視與加強護理同事間同儕互動，並強化關懷氛圍的職場環境，更是醫院主管與行政主管未來必須積極面對的重要任務

關鍵字

護理工作認知；護理工作環境；離職意願

並列摘要

Abstract 　　Nurses make up the largest and an important workforce in the hospital. If there is no stable long term nursing workforce, it may affect the quality of care in the short run, and may even result in severe incidences, putting patients’ lives in danger. Therefore, realizing the importance of retaining nurses early is crucial and can allow the nurses to develop professional edge and expertise. Retaining a long-term nursing workforce can also help nurses develop confidence in their job and thus provide better quality of care for patients. Policy and strategic measures to retain the nursing workforce and reduce the turnover rate are imperative. The purpose of this study was to investigate job recognition, work environment and factors on the turnover of clinical nurses. The study employed cross-sectional study design, using non-random sampling to recruit clinical nurses from three hospitals in southern Taiwan. Data were collected by structural questionnaires, with a total of 700 questionnaires given and 674 valid questionnaires returned; the return rate was 96.3%. The questionnaire included questions on demographic data, job-related information, nursing job recognition scales, nursing work environment scale. All analysis were done using SPSS for Windows 18.0 software package. Descriptive statistics was used for characterizing the distribution of demographic information, work-related factors, nursing job recognition, work environment and turnover intention scale. Bivariate analysis were used on demographic information, work-related factors, nursing job recognition, and work environment; and regression analysis was used to investigate the important factors for the turnover of the nursing workforce. 97.8% of the subjects were female with average age of 29.7 years old and average working year of 7.05 years. 58.2% worked in a medical center; 55.2% in general medical unit (internal and surgical unit) and 39.7% in specialty units. Factors for turnover included marriage status, work unit, work organization, work shift, job recognition, and work environment. The regression analysis showed six important factors to determine turnover, explaining 29.1% of the variations, and the factors were job recognition (16.5%), organizational atmosphere and work environment (5.0%), work unit (3.1%), adequate nursing workforce and other resource(1.7%), peer interaction (1.1%),spouses(0.9%),work organization (0.8%) and work unit(0.8%) . The study result showed that factors for turnover closely related to personal factors, career recognition, and the work environment. It is thus recommended for the management level of the hospital to recognize the importance of this issues. It is critical to improve job recognition of the nursing staff as well as to establish the mechanism for the specialization of nursing units. Work-related factors, nursing job recognition, work environments were variables significantly related to the turnover of the nursing workforce, which reflected the importance of having a professional identity and support system for nurses. The result of the study also called for an evaluation for the improvement on work environment, work force and human resource of the nursing profession. In addition, appropriate adjustments of specialty work burden between units, recognition and improvement of peer interaction among nursing colleagues and strengthening of the caring atmosphere in the workspace are important tasks for the management level and hospital executives.