護理人員對於專科護理師角色的認同感與轉任意願之探討—以南部某區域醫院與地區醫院為例

研究目的爲因應醫師人力不足之困境以及促進護理專業之發展同時，專科護理師制度自民國87年實施至今，專科護理師對病人的照護有很大的影響。各醫療機構均積極培育進階護理人員擔任專科護理師以輔助醫療照護服務，然而，於醫院任職的資深專科護理師卻無增加趨勢。因此本研究旨在探討護理人員對於專科護理師角色之看法以及可能影響轉任意願之相關因素。研究方法本研究採橫斷面結構式問卷調查，以南部某區域醫院與地區醫院，針對在有專科護理師任職之臨床單位其領有護理師證照護理人員，包括護理師、副護理長、及單位護理長為對象、樣本數共 355人，問卷有效回收334份。使用『專科護理師角色能力問卷量表』進行資料收集。本研究經人體試驗委員會審查通過，調查問卷亦經5位專家進行專家內容效度之審查，平均CVI為0.963，問卷施測前之預試，內在一致性信度係數Cronbach’s ɑ為0.847~0.975，問卷資料以 SPSS 20.0中文版套裝軟體進行描述性統計、t檢定、F檢定、Pearson相關及複迴歸分析。研究結果結果顯示，對專科護理師之認同度高達81.6%，其中以角色構面二（自主性與指示性病人照護能力）之認同度最高(p = .015)。人口學與工作屬性方面，經順向逐步淘汰複迴歸分析發現，婚姻(p = .019)與認為專師工作滿意度(p<.0005)對於總角色(log)認同有顯著相關，已婚以及認為專科護理師工作滿意度越高者對於角色認同度越高，但僅有年齡(p = .002)與轉任有顯著相關，年齡直接可以影響轉任意願，年齡越高影響越大。專科護理師角色認同之角色自主與指示性病人照護能力(p = .015)、教學指導能力(p = .021)與轉任專科護理師的意願有顯著相關性，護理人員對於專科護理師臨床角色以及護理相關之教學指導及品質監測能力之認同度越高，其轉任專科護理師之意願也會提高。針對中介變項，透過角色認同的交互作用，僅有薪資影響轉任意願(p = .050)，薪資越高且角色越認同，對於轉任意願影響也越大。結論與建議本研究發現，年齡、薪資以及認同專科護理師之角色能力對於轉任專科護理師意願有顯著相關。在醫護合作的照顧模式下，專科護理師之業務範圍會因執業場所及人力分配的不同而有所差異，護理人員對於專科護理師之角色認知、醫院對專科護理師角色的工作內容界定不清楚、或醫療部與護理部對於專科護理師角色的工作內容看法不一致⋯⋯等，仍是存在的問題。對於專科護理師之聘任，若能推廣衛生署及專科護理師學會致力於專科護理師在醫療實務之重要角色肯定以及各項政策擬定與修改，增進各醫療人員與病人對於專科護理師角色的認知，有助於提高專科護理師專業水平及增加其能見度。更能付予相對於專業的付出與壓力下較高的薪資，相信在於照護體系下，對於護理師成功轉任專科護理師的比率定有其助益。此研究為橫斷面結構式問卷調查，以自填式問卷方式收集問卷，問卷之內容中執業範圍項目未能依不同專科性之專科護理師執業範疇加以分類比較，亦缺乏質性資料佐證，而無法深入探討影響轉任專科護理師意願的相關因素。建議，專科護理師是目前照護體系上不可或缺的角色，未來之研究若能整合其訪談之質性資料與問卷之量性資料，以彙整分析之研究方法，進一步的分析以了解影響轉任專科護理師意願之相關因素，期望在有限的醫療資源下提供最佳的醫療照護必有正面的助益。

關鍵字

專科護理師；角色認同；轉任意願；問卷調查；複迴歸分析

並列摘要

Objectives To deal with the shortage of doctors and also promote the development of nursing profession, the nurse practitioner system, which was designed to help in caring patient, was setup in 1998. Since then many medical institutes trained and promoted senior nurses as nurse practitioners. However, even if more and more resources were spent in training nurse practitioners, the number of nurse practitioners does not increase correspondingly. The goal of this study is to understand the job recognition of nurse practitioners from the perspective of a nursing staff and figure out the factors which may affect a nurse taking the role of being a nurse practitioner. Methods In this study, a cross-sectional structured questionnaire survey was conducted in a regional hospital of the southern Taiwan. The survey was targeted to those nursing staff in a clinical unit with a specialist nursing staff, including nurse practitioner, deputy care worker and deputy nurse practitioner. A total of 355 questionnaires were disturbed and 343 copies of answered questionnaires were received. A scale to measure the job recognition and capability of nurse practitioner was used in the data collection. This study was reviewed by the Human Body Test Committee and the content of the questionnaire was also reviewed by five experts for expert content validity. The average CVI was 0.963 and before running the survey, the internal consistency reliability coefficient (Cronbach's ɑ) was 0.847 ~ 0.975. The survey data were analyzed by SPSS 20.0 (Chinese version) to do the statistical analysis – t-test, F-test, Pearson correlation and complex regression analysis. Results The results show that the job recognition of being nurse practitioners is 80.0% especially for the active and passive patient care (p = 0.015). Marriage (p = 0.019) and job satisfaction (p < 0.0005) are the major factors in determining the job recognition. On the other hand, age plays an important role (p = 0.002) in determining the willingness to be nurse practitioner -- the higher the age is, the larger the impact on the willingness. Furthermore, those with higher capability in active patient caring (p = 0.015), higher leadership (p = 0.021) and quality monitoring capability (p = 0.038) are more willing to be nurse practitioners. Moreover, salary is a critical factor for a nursing staff to consider to take the role of being nurse practitioners (p = 0.050). Increasing salary can help to attract nursing staff to be nurse practitioners. Conclusion and suggestions The study finds that age, salary and job recognition of nurse practitioners were critical factors for a nursing staff to take the role of nurse practitioners. Under the medical and nursing mutual cooperation, the job scope of nurse practitioners varies. It actually depends on the working environment, available resources and other’s job recognition toward nurse practitioners, etc. Should nurse practitioners can involve in medical and health policy planning, this can raise the profession of nurse practitioners and increase their salary correspondingly. This can then in turn help to attract more nursing staff to be nurse practitioners. This study is based on a cross-sectional structured questionnaire survey, which requests the interviewees to answer the questions. The content of the questionnaire is designed for general nurse practitioners. Thus, the study may not be specific enough to those nurse practitioners working in some specific sections. Actually, nurse practitioners in some specific section are irreplaceable. Thus, in the future study, the questionnaires should take the job nature into account to quantitatively analyze the willingness of being a nurse practitioner. With this enhancement, the study can provide constructive suggestions to the policy planners.