台灣專科護理師服務現況調查～2014年結果

背景：提供優質照護服務與促進病人健康是醫療照護的核心目標，跨專業的團隊分工與協作則是達到此目標的重要策略，專科護理師具備專業職能，與醫師共同提供連續性及整合性的護理與醫療照護，在各層級醫院中扮演了重要的角色，因此專科護理師服務現況與留任影響因素均為醫事人力規劃政策的重要議題。目的：本研究目的在探討專科護理師在醫院內的組成結構、工作現況與留任意願影響因素。方法：本研究採問卷量測方式進行，共有702位專科護理師回覆問卷，回覆率68.5%。結果：研究發現專科護理師人力八成以上集中於區域醫院（65.7%）與醫學中心（22.4%），僅一成服務於地區醫院（11.8%）。48.1%的醫院，專科護理師需值小夜班，23.1%的醫院，專科護理師需輪值大夜班；專科護理師平均每週工作時數為49小時，且區域醫院顯著高於醫學中心。專科護理師的工作班別、臨床業務與行政的工作負荷、工作執業範圍的不明確，醫院的薪資福利制度與專科護理師未來的職涯發展與規劃、直屬主管的領導方式、與工作夥伴的關係，皆是影響專科護理師留任的重要因素。結論：明確定義與規範專科護理師的執業範疇，營造安全且具有磁性的執業環境供護理人員更安心執業，是目前醫藥衛生管理單位與各醫院的首要任務。

關鍵字

專科護理師；臨床執業；留任

並列摘要

Background: The goal of healthcare is to providehigh quality of care and to improve health status of patients. Multidisciplinary collaboration and teamwork are keys to achieve this goal. Nurse practitioners (NPs) possess professional competencies, together with physicians can provide patients continuous and integrated nursing and medical care. NPs play important health care roles in different levels of hospitals in Taiwan. Therefore, the NPs' practice conditions and influencing factors of job retention are important information for medical staff planning policy making. Purpose: The purpose of the study is to explore the positions within the organized structure, practices status, and factors influencing job retention intention of NPs in the hospitals. Methods: The study was a questionnaire survey. There were 702 NPs completed and returned the study questionnaires. The respond rate was 68.5%. Results: More than 80% of the NPs worked in the regional hospitals(65.7%) and the medical centers(22.4%), and only 11.8%worked in the local hospitals. There are about 46.8% of the hospitals to establish the promotion evaluation system for the NPs, and 26.1% of the hospitals built their own advanced grading system for the NPs, so each NP have to be on shift or on duty according to the common duty schedules in order to be evaluated well. This study found that every NP worked at least 49 hours each week, and the working hours of the NPs in the regional hospital are more than those in the medical centers. The key factors influencing the staff retention of NPs include work-shift, loading of clinical practices and administrative works, indefinite scope of medical practices, system of pay and benefits from the hospital, future career developments, leadership of the direct supervisor, and interactive relationships with co-workers. Conclusions: The primary tasks for the health authority and each hospital are to define and regulate clearly the scope of practices of the NPs and to create the safe and charming clinical environment for them.