台灣臨床護理人員執業環境與職業壓力、離職意圖之探討

The relationship between work environment, occupational stress and intention to leave among nurses

李育茹(Yu-Ju Li)

指導教授 ： 蕭淑銖

國立臺灣大學/醫學院/護理學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.02678

摘要

研究目的：了解護理執業環境、職業壓力及身心健康現況，分析執業環境壓力源對護理人員身心健康之影響，並進一步探討影響護理人員離職意圖之因素。
方法：本研究利用問卷進行橫斷性研究，依「分層抽樣法」於全國醫院評鑑優等之醫院，確認抽樣醫院、單位與人數後，將問卷郵寄至抽樣醫院之護理部，再由醫院協助抽出內外科病房、產兒科病房、精神科病房、加護病房、手術室、急診及門診之護理人員。問卷內容包括：臨床護理人員職業特質壓力量表、職場疲勞量表、工作特質量表、華人健康量表及個人資料五大部分，並使用JMP10.0統計軟體進行分析。以描述性統計呈現個人資料變項、執業環境壓力源、職業壓力與離職意圖的分布情形，再以羅吉斯迴歸(logistic regression)探討護理人員離職意圖的因素。
結果：共發出2,966份問卷，回收2,354份（回收率79.4%）。護理人員的平均年齡為30.9歲(標準差7.0)，平均目前工作年資為7.4年(標準差6.5)，平均護理總工作年資為9.1年(標準差7.2)。上班時間每日平均9.2小時，每週工時平均為48.8小時。以一般病房平均護病比人數來看，區域醫院及地區醫院之白班護病比為9.6人以上，高於醫學中心之7.5人；小夜班護病比為10.9人以上，其中區域醫院達15人；大夜班護病比為14人以上，而區域醫院18人更接近白班照護病人數兩倍。有41.9%的受試者表示延遲下班若超過一小時，不常或從未得到應有的加班費或補休。有84.2%認為工作會影響健康，只有6.3%認為工作不會影響健康。進一步評估身心健康得知，「覺得睡眠不好」(58.3%)、「覺得許多事情是負擔」(53.3%)、「頭痛或頭部有壓迫感」(46.4%)則為臨床護理人員覺得健康比平時較差的前三項。就工作是否帶來很大的壓力而言，有17.1%的護理人員覺得工作一向會帶來很大的壓力，37.1%常常有很大的壓力，且一向、常常有很大的壓力的護理人員其身心健康不佳的風險是從未或很少有很大壓力的5.83倍。其中若以執業環境壓力源來看，高團隊關係壓力、低工作控制及高工作家庭衝突，對身心健康會顯著造成負面影響。由描述性統計結果，使臨床護理人員確定離職的因素，前五名依序如下：健康受到影響18.0%、家庭因素(如結婚)12.4%、輪班12.0%、工作超時9.9%、休假時間不足9.5%。由羅吉斯迴歸分析發現，離職意圖和護理工作總年資、個人疲勞、對服務對象疲勞、職場缺乏正義及工作家庭衝突之間有相關(P<0.01)。且中度以上職場正義為離職意圖保護因子，當護理人員感受到高職場正義，其離職意圖的OR值為感受到低職場正義的0.22倍(95%CI：0.11-0.43)。
結論與建議：本研究結果發現我國醫院護理執業環境有高團隊關係壓力及高工作家庭衝突等因素導致身心健康不佳，並且執業環境中工作忙碌、高無力感與病人死亡壓力、高團隊關係壓力、高暴力騷擾危害壓力、高職業危害暴露壓力、高工作負荷、低工作控制、高工作家庭衝突等導致護理人員有高個人疲勞情形；高護病關係壓力、高團隊關係壓力、高暴力騷擾危害壓力及高工作家庭衝突等導致護理人員有高對服務對象疲勞情形，這些疲勞感受會進一步導致護理人員離職意圖，故建議臨床單位應針對執業環境壓力源給予協助，並提高職場正義，讓護理執業環境對護理人員更具吸引力，同時維持健康的護理人力；建議政府單位對護理人員照護病人數及工時應有所改善，若能有充足人力應能減低其工作負荷；建議學術單位持續利用「臨床護理人員職業特質壓力量表」作為主要研究工具進行相關研究，以期作為未來改善、建立護理人員安全、健康之執業環境策略修訂之參考。

關鍵字

護理人員 ； 執業環境 ； 職業壓力 ； 身心健康 ； 離職意圖

並列摘要

Objective: To understand the nursing work environment, occupational stress, health status, and the impact of environmental stressors on physical and mental health of nurses. Further, to identify the factors that influence nurses' intention to leave.
Methods: A cross-sectional questionnaire study using stratified random sampling method among the excellent hospitals accredited by the National Hospital Accreditation. Questionnaires were delivered to the sampling hospitals, and units sampled included surgical wards, gynecology and pediatric wards, psychiatric wards, intensive care unit, operating room, emergency room and outpatient department nurses.
The questionnaire included the following contents: clinical nursing career traits stress scale, occupational burnout inventory, job content questionnaire, the Chinese Health Questionnaire and demographics. The JMP version 10.0 statistical software was used for data analysis. Descriptive statistics including demographics, the distribution of nursing occupational stress and stressors of work environment. Logistic regression was used to identify factors that influence nurses' intention to leave.
Results: A total of 2354 full-time nurses completed the questionnaires (79.4% response rate). The mean age was 30.9 years (SD 7.0), and the average job tenure was 9.1 years (SD 7.2). The average working hour per day was 9.2 hours and 48.8 hours per week. The patient-nurse ratio at general wards of regional and local hospitals was 9.6, and 7.5 at tertiary hospitals. Up to 41.9% of the nurses would not/seldom be compensated even if they worked overtime longer than one hour. Up to 17.1% of nurses agreed that their work always bring tremendous pressure to them whilst 37.1% often felt so. In terms of work environment associated stressors, high pressure between team members, low job control and high work-family conflict, were significantly associated with adverse affects in physical and mental health of nurses.In addition, major factors influencing nurses’ intention to leave are: deteriorating health (18.0%), family associated factors, such as getting married (12.4%), shift work (12.0%), working overtime (9.9%), and insufficient off days(9.5%).The logistic regression analysis identified that the most important risk factors predicting nurses’ intent to leave their job including: “personal burnout”, “client-related burnout”, “poor workplace justice”, and “high Chinese Health questionnaire score” (indicating more health and psychological problems), and shorter work tenure as a nurse.
Conclusions and Recommendations: This study found that high pressure between team members and high work-family conflicts were associated with self-perceived poorer physical and mental health in nurses. Busy work, high level of feeling powerlessness and patient death, high pressure between team members, high level of violent harassment hazard, high level of being exposed to occupational hazards , overly work loaded, low job control, and highly work-family conflict were significantly correlated with nurses burnout. High level of client-related burnout was also found to have significant impact on nurses ‘consideration of leaving job.
Using the above findings, we were able to identify existing risk factors for nurses’ occupational stress and their intention to leave nursing profession. Further study will be needed to confirm these findings, and to develop strategy for improving the safety and health concerning psychosocial environment of nurses.

並列關鍵字

nursing staff ； work environment ； job stress ； physical and phycosocial health ； intention to leave

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