護理工作生活品質、護理人員離職傾向與護理人員離職關係

Relationships among Quality of Nursing Work Life, Nurses’ Intention to Leave and Nurses'Turnover

李雅文(Ya-Wen Lee)

指導教授 ： 戴玉慈

國立臺灣大學/醫學院/護理學研究所/博士(2014年)

https://doi.org/10.6342/NTU.2014.02731

摘要

背景：國際護理協會2009年調查護理人員的期待與需求顯示臺灣的護理工作環境欠佳，護理工作環境欠佳致使護理人員流動率高，臺灣護理人員的年流動率為20%。護理工作生活品質在護理人員的流動上扮演一個重要的角色，尚未有文獻探討護理工作生活品質與護理人員確實離職間的直接和間接關係。
目的：本研究目的主要有兩個，分別是(1)探討護理工作生活品質與三種離職發生(離開工作單位、離開工作機構與離開護理專業)的直接關係以及(2)探討三種離職傾向(離開工作單位的傾向、離開工作機構的傾向以及離開護理專業的傾向)與護理工作生活品質及三種離職發生的中介作用。
設計：本研究屬於縱貫面的研究設計，追蹤同一群護理人員一年後離職發生的情況。
方法：在2012年及2013年於臺灣中部七家急性醫院，以立意取樣的方式選擇研究對象。樣本納入條件是所有輪三班執行第一線臨床照護的護理人員，排除對象是試用期內的新進護理人員及護理長以上的護理管理階層及非輪三班單位的護理人員，人數共1,283位，一年後追蹤人數為1,231位，流失率為4.1 %。研究工具共有四種：第一種是中文版護理工作生活品質量表；第二種是護理人員離職傾向量表；第三種是護理人員實際去留狀況紀錄表；第四種是護理人員個人屬性變項與工作相關變項。以IBM SPSS 20.0英文版統計軟體分析，以描述性統計呈現個人屬性變項與工作相關變項、護理工作生活品質、離職傾向、離職發生的分布情形，再以卡方檢定及t檢定、二元邏輯斯迴歸分析、累積邏輯斯迴歸模型檢驗護理工作生活品質、離職傾向與離職間的關係。
結果：護理人員的平均年齡為29.2歲(標準差4.94)、平均工作年資為6.57年(標準差4.94)，護理工作生活品質單題平均值得分最高的前三名分別為”對我而言，與同事間的友誼是重要的”、”我覺得我是工作團隊的一份子”及”我覺得在我的工作場合有團隊合作”， 而單題平均值得分最低的後三名分別為”工作場合，安排很多課程，佔用太多休息時間”、”在我每天工作的常規中，我受到許多干擾”及”工作場合，基本的休假天數無法完全安排”。護理人員離開工作單位或離開工作機構或離開護理專業的傾向分別為45%、51.8%及58.5%，一年後離開工作單位或離開工作機構或離開護理專業則分別為8.7%、7.6%及2.5%，「整體護理工作生活品質」、「工作生活與家庭生活平衡」工作生活品質構面可預測一年後護理人員離開工作單位;「整體護理工作生活品質」可預測一年後護理人員離開工作機構;「尊重與自主的環境」工作生活品質構面可預測一年後護理人員離開護理專業;護理人員離開工作單位的傾向是「整體護理工作生活品質」及六個工作生活品質構面：「安全、專業認同、支持的環境」、「工作安排與工作量」、「工作生活與家庭生活平衡」、「護理主管的管理風格」、「護理人力與病人照護」、「尊重和自主的環境」與護理人員一年後是否離開工作單位的中介變項；護理人員離開工作機構的傾向是四個工作生活品質構面：「工作安排與工作量」、「護理主管的管理風格」、「護理人力與病人照護」、「尊重和自主的環境」與護理人員一年後是否離開工作機構的中介變項；護理人員離開護理專業的傾向是「尊重和自主的環境」與護理人員一年後是否離開護理專業的中介變項。
結論與建議：護理工作生活品質與離職發生有直接關係，離職傾向為護理工作生活品質與離職發生的中介變項。未來研究可以將護理工作生活品質視為自變項或改善工作環境的結果變項或探討與病人照護結果的關係。

關鍵字

護理工作生活品質 ； 工作生活品質 ； 工作環境 ； 離職傾向 ； 離職 ； 中介作用

並列摘要

Background: In a 2009 study by the International Council of Nurses that examined nurses’ expectations and needs globally, the proportion of nurses in Taiwan who believed that nursing work environment was getting worse. The getting worse work environment will lead to nurses highly turnover. The annual turnover rate in Taiwan is 20 %. Quality of work life (QWL) plays a significant role in nurse turnover. However, very limited attention has been given to exploring the direct and indirect relationships between QWL and nurses turnover.
Aims: The purposes of this study were that (1) to explore the direct relationships between QWL and three-type nurses turnover of that to leave units, leave the organization and leave nursing profession, and (2) to explore the indirect relationships among three-type nurses’ intention to leave, which are intention to leave units, intention to leave the organization and intention to leave nurse profession, QWL and three-type nurses turnover.
Designs: The study design was a longitudinal and correlational study. To follow up the same nurses turnover one year latter.
Methods: Participants were recruited using purposive sampling from seven acute care hospitals in central Taiwan at 2012 and 2013. Inclusion criteria were nurses who provided bedside care and worked on three rotating shifts; exclusion criteria were nurses who were still in the probation period. A total of 1,283 questionnaires were delivered to nurses, and 1,231 nurses were follow-up after one year. The loss rate was 4.1 %. Four questionnaires—the Chinese version of the Quality of Nursing Work Life scale, a Intention-to-leave questionnaire, the records of nurses turnover and a demographic questionnaire for individual- and work-related variables—were used for collecting the data. All analyses were conducted with IBM® SPSS® English version 20. We used descriptive analyses to examine individual- and work-related variables, QWL, intention to leave and turnover measures. We performed chi-square tests, t-tests, binary logistic regression and cumulative logistic regression to assess the relationships among QWL, nurses’ intention to leave and nurses turnover.
Results: The mean age of nurses was 29.2 years old (SD = 4.94), with an average service length of 6.57 years (SD = 4.94). The top three ranking of mean of QWL were “friendships with my co-workers are important to me”, “I feel like I belong to the work team”, and “I feel that there is teamwork in my work setting”. The lowest three ranking of mean of QWL were “I have to participate in many lectures which occupy my after work time in my work setting”, “I experience many interruptions in my daily work routine”, and “It difficult for me to arrange my holidays in my work setting”. Nurses’ intentions to leave units, the organization and nursing profession were 45%, 51.8%, 58.5%, and nurses turnover rates were 8.7%, 7.6% and 2.5% after one year, respectively. Total QWL and the QWL of work life/ home life balance can predict nurses leave the units after one year. Total QWL can predict nurses leave the organization after one year. The “milieu of respect and autonomy” QWL can predict nurses leave nursing profession after one year. The mediating effects of intention to leave the units were in the relationships between total QWL, the six QWL dimensions of “supportive milieu with security and professional recognition”,” work arrangement and workload”,” work/ home life balance”,” head nurse’s/ supervisor’s management style”,” nursing staffing and patient care”, and “milieu of respect and autonomy” and nurses leave the units. The mediating effects of intention to leave the organizations were in the relationships between the four QWL dimensions of “work arrangement and workload”,” head nurse’s/ supervisor’s management style”,” nursing staffing and patient care”, and “milieu of respect and autonomy” and nurses leave the organizations. The mediating effect of intention to leave nursing profession was in the relationship between the “milieu of respect and autonomy” QWL dimension and nurses leave nursing profession.
Conclusions and Suggestions: There were direct relationships between QWL and nurses turnover, and there were also mediating effects among QWL, nurses’ intention to leave and nurses turnover. Further researches can be seen QWL as independent variable or the outcome variable to improve the work environment or explore the relationships between QWL and patients care outcomes.

並列關鍵字

quality of nursing work life ； quality of work life ； work environment ； intention to leave ； turnover ； mediating effect

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