護理人員工作環境、異常管理、工作壓力與離職意願之探討

護理人力短缺是當代醫療照護人力資源十分嚴重的問題，人員離開職場的原因和樣態非常多元。本研究目的為探討護理人員工作環境、異常管理、工作壓力與離職意願之關係。採橫斷式調查研究，以方便取樣選取南部兩家醫院，再依員工數以簡單隨機抽樣分別抽取服務於門診、病房、重症單位工作滿3個月以上的全職護理人員樣本各120名及380名。結構式問卷包含護理人員人口學特性調查表、護理工作環境量表、異常管理量表、工作壓力量表及離職意願量表，共計發出問卷500份，回收479份，有效問卷473份，有效問卷率為94.6％。以JMP 11.0版統計軟體進行資料處理及分析。結果發現：（1）本研究之護理人員對護理工作環境及異常管理的認同程度平均分數，分別屬於中高度及高度的認同（百分位分別為63.78%和75.61%），有22.41%護理人員以付出/回饋失衡呈現工作壓力，離職意願平均分數則屬中低程度（百分位為35.20%）。（2）無工作壓力之護理人員在感受其護理工作環境（護理主管的支持、文化價值、自主性、醫護關係、工作任務、專業性與合作、薪資、人力足夠度及參與決策）、護理工作滿意度、異常管理等變項相對於有工作壓力者明顯正向。（3）以邏輯迴歸分析發現，容易發生工作壓力的護理人員比較是有過度投入（OR＝3.82）、自主性感受低（OR＝2.42）、工作滿意度低（OR＝1.83）及異常管理認同度低（OR= 1.35）。（4）以t檢定及變異數分析發現，離職意願顯著較高者之人口學特性為護理師、非主管、N1以下、工作科別（ICU、內科、外科）、輪三班、未婚及住醫院宿舍、有過度投入者及有工作壓力者；以皮爾森積差相關係數分析發現，離職意願與年齡、護理工作環境、護理工作滿意度、異常管理等變項達顯著負相關。（5）以階層迴歸分析離職意願的預測因子與個別解釋變異量，模式一中，人口學特性解釋變異量（工作於ICU單位、輪三班、工作滿意度）為36.69%；模式二中，加入過度投入之單獨解釋變異量為1.77%；模式三中，加入護理工作環境及異常管理後，解釋變異量增加7.08%；模式四中，加入工作壓力後，解釋變異量再增加1.46%，此階層迴歸分析之總解釋變異量為47.04%。本研究結果顯示離職意願與護理工作環境、異常管理及工作壓力有顯著相關，且發現過度投入對工作壓力發生之機率將近四倍，個人應察覺及嘗試調整過度投入的心態，同時護理部門主管應持續改善護理工作環境及異常管理，增加人員的正向感受，進而達到降低人員離職意願之目的。

關鍵字

護理工作環境；異常管理；工作壓力；付出/回饋失衡(ERI) ；離職意願

並列摘要

Nursing shortage is a serious human recourse issue of the modern healthcare system. The reasons for staff turnover are multifaceted. The study aimed to explore the relationships among work environment, work stress, incident management and intention to leave. A cross-sectional designed study, with convenience sampling from two hospitals in southern Taiwan, was conducted. Full-time employed nurses who have worked for more than three months in the hospitals were randomly selected as proportionated by the employee numbers. Their work settings included outpatient and inpatient departments and critical care units. The respective samples from the two hospitals were 120 and 380. The structured questionnaire contained demographic data, perceptions of nursing work environment, incident management, and work stress and intention to leave. Among the 500 questionnaires, 479 were returned and 473 (94.6%) were valid. The data were analyzed with JMP 11.0 statistical software. The study results showed: (1) The mean scores leveled medium-high (63.78%) for nursing work environment; high for incident management (75.61%); and medium-low (35.20%) for intention to leave. Nurses’ work stress as measured by effort-reward imbalance was reported by 22.41% of the participants. (2) Effort-reward balanced nurses perceived significantly more positive than their counterparts on work environment (including nurse manager’s support, cultural values, autonomy, nurse-physician relationship, task content, professionalism and cooperation, pay, adequate staffing, and shared governance), work satisfaction, and incident management. (3) The analyses of logistic regression showed that the odds for work stress is higher for nurses who perceived over-commitment (OR＝3.82), low autonomy (OR＝2.42), low work satisfaction (OR＝1.83), and low incident management (OR=1.35). (4) The analyses of t-test and ANOVA showed that higher intention to leave was reported by nurses who were with higher professional certificate, non-manager, low clinical ladder, working in ICU and medical-surgical units, working by shifts, unmarried and living at dormitory, over-commitment, and effort-reward imbalanced. The analyses of Pearson correlation coefficient showed that age, work environment, work satisfaction, and incident management were significantly negative correlated to intention to leave. (5) The analyses of hierarchical regression were conducted for predicting factors of intention to leave and the respective explained variance. Intention to leave was significantly predicted by working in ICU, working shifts, and work satisfaction (36.69% explained variance) in model 1; by over-commitment (1.77% explained variance) in model 2; by work environment and incident management (7.08% explained variance) in model 3; and by work stress (1.46% explained variance) in model 4. The total explained variance was 47.04%. The study results reveal that intention to leave is significantly related to nurses’ work environment, incident management, and work stress. Nurse’s over-commitment has the most influence, with close to four times odds, to the work stress. Therefore, clinical nurses have to be aware of and try to cope with their inner-self with over-commitment. Moreover, to increase the positive perceptions among nurses, nurse managers should continue to improve the work environment and incident management. The ultimate goal is to decrease the nurses’ intention to leave.

並列關鍵字

Nurse's Work Environment ； Incident Management ； Work Stress ； Effort-Reward Imbalance (ERI) ； Intention to Leave

參考文獻

錢才瑋、王文中、周銘霆、張志誠（2012）．以中文版工作內容問卷（C-JCQ）評估醫院基層員工之工作壓力．醫務管理期刊，13(2)，79-94。doi:10.6174/jhm2012.13(2).79

Friese, C. R., Lake, E. T., Aiken, L. H., Silber, J. H., & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145–1163. doi:10.1111/j.1475-6773.2007.00825.x

中文參考文獻