台灣醫院護理人員遭遇職場霸凌現況及其相關因素

Current situation and related factors of workplace bullying among hospital nurses in Taiwan

馬淑清(Shu-Ching Ma)

指導教授 ： 王秀紅

高雄醫學大學/護理學院/護理學系研究所/博士(2014年)

摘要

背景：職場霸凌是工作環境中的一個重要議題，雖然它會發生在各個職業場域，但從許多研究顯示，醫療照護體系的職場霸凌盛行率較其他職業高出許多，其中，護理人員又被公認是醫療照護體系中最容易發生或遭遇職場霸凌的群體。許多文獻指出，護理人員若長期經歷職場霸凌，將對其個人及所屬醫療機構產生許多不良的影響。西方國家之護理專家或人力資源管理學者都已紛紛投入心力關注職場霸凌這個重要的議題，並試圖尋找解決方案，反觀我國，以職場霸凌為主題所發表的研究或文章仍相當缺乏，因此引發進行本研究之動機。
目的：本研究旨在探討(1)護理人員遭遇職場霸凌的現況；(2)比較遭遇職場霸凌護理人員與未遭遇職場霸凌護理人員在個人因素、組織因素、對個人的影響及組織影響的差異；以及(3)探討護理人員親身遭遇職場霸凌的風險因子及危險因子對遭遇霸凌護理人員的個人及組織的影響。
結果：醫院護理人員職場霸凌事件發生比例為32.1%；親身遭遇職場霸凌者157位(19.4%)，施予霸凌的主要來源為醫師(29.6%)，其次為同儕(26.8%)。醫院護理人員目賭職場霸凌者239位(29.5%)，目睹施予霸凌的主要來源為同儕(36%)，其次為醫師(28.3%)。157位遭遇職場霸凌者在職場霸凌量表整體平均得分值為1.52(標準差0.47)，三個構面得分由高至低，分別為「工作相關霸凌」、「人身攻擊霸凌」、「身體恐嚇型式霸凌」。在22個職場霸凌行為題項中，得分前五名的行為由高至低依序為：「生氣時對我大聲咆哮或把我當成出氣筒」、「譏諷或羞辱我的工作」、「有人會散佈關於我的謠言」、「指派我去做低階的工作」、「對我視若無睹或把我當成空氣」。遭遇職場霸凌護理人員與未遭遇職場霸凌護理人員在個人因素除年齡別有差異外(當年齡別大於34歲以上時，遭遇職場霸凌的護理人員之比例比未遭遇職場霸凌護理人員的比例多出11.5%)，其它皆無顯著差異。遭遇職場霸凌護理人員與未遭遇職場霸凌護理人員在組織因素有顯著差異；亦即，主管領導型態傾向民主型，未遭遇職場霸凌護理人員的比例比遭遇職場霸凌護理人員的比例高出5.7%；以及主管領導型態傾向專制型，遭遇職場霸凌護理人員的比例比未遭遇職場霸凌護理人員的比例高出12.7%。組織文化傾向官僚型，遭遇職場霸凌護理人員的比例比未遇職場霸凌護理人員的比例高出13.8%；組織文化傾向支持型，未遭遇職場霸凌護理人員的比例比遭遇職場霸凌護理人員的比例高出5.4%；組織文化傾向混合型，未遭遇職場霸凌護理人員的比例比遭遇職場霸凌護理人員的比例高出11%。
遭遇職場霸凌護理人員與未遭遇職場霸凌護理人員在個人影響與組織影響比較具有顯著差異；亦即，遭遇職場霸凌護理人員在心理健康困擾、自殺意念、職場勞、離職意圖等變項的得分皆比未遭遇職場霸凌護理人員較高；遭遇職場霸凌護理人員比未遭遇職場霸凌護理人員工作滿意度低。以邏輯迴歸單變量分析進行檢定，結果發現，年齡別34歲以上之護理人員相較於年齡別34歲以下(含34歲)之護理人員，遭遇職場霸凌的危險多出1.74倍；主管領導型態傾向專制型之護理人員相較於主管領導型態傾向混合型之護理人員，遭遇職場霸凌的危險多出3.63倍；所屬組織文化傾向創新型之護理人員相較於所屬組織文化傾向混合型之護理人員，遭遇職場霸凌的危險多出1.86倍；所屬組織文化傾向官僚型之護理人員相較於所屬組織文化傾向混合型之護理人員，遭遇職場霸凌的危險多出3.72倍。將年齡別、主管領導型態、組織文化等危險因子及職場霸凌對護理人員個人影響及組織影響等變項以線性迴歸分析進行檢定。結果發現：職場霸凌危險因子及職場霸凌對護理人員的心理健康困擾、自殺意念、職場疲勞、離職意圖、工作滿意度及組織公民行為有顯著影響，但解釋變異量不高。
結論：本研究提供了我國醫院護理人員遭遇職場霸凌的相關實證資料，結果可做為政府、醫療體系及護理行政管理者未來在建構優質護理職場時的重要參考依據。

關鍵字

護理人員 ； 職場霸凌 ； 人格特質 ； 權力距離 ； 主管領導型態 ； 組織文化 ； 心理健康困擾 ； 職場疲勞 ； 離職意圖 ； 工作滿意度 ； 組織公民行為

並列摘要

Background: Workplace bullying is an important issue. Although it occurs in all occupations, studies have shown that the prevalence of workplace bullying in the healthcare workers is much higher than in other occupational groups. Among them, nurses were identified as the most vulnerable to workplace bullying. Many research indicated that nurses being subjected to long term bullying had a negative impact on their personal lives and the organizations they work for. In western countries, many nursing scholars and human resource professionals have been making an effort to prevent or reduce workplace bullying. In Taiwan, there is still a lack of studies focusing on workplace bullying and this created my motivation to conduct the research.
Aim: The aim of this study is to explore the current situation of workplace bullying in nurses, to compare differences in individual factors, organizational factors, and the impacts of workplace bullying on personal and organizational outcomes between nurses who had and those who had not been bullied, and to investigate risk factors for workplace bullying and their impact on personal and organizational outcomes.
Results: The rate of workplace bullying was 32.1%. Among the 157 (19.4%) nurses who had been bullied, physicians (29.6%) were the main perpetrators, followed by colleagues (26.8%); 239 (29.5%) nurses had witnessed workplace bullying with the main perpetrators being colleagues (36%), followed by physicians (28.3%). The average score on workplace bullying scale for the 157 cases being bullied was 1.52 (standard deviation=0.47), with the highest on the dimension of work-related bullying, followed by personal-related bullying and physical-intimidation. The top five bullying behaviors were: 1) being shouted at or being the target of anger, 2) work being ridiculed, 3) being gossiped about, 4) being ordered to do work below my level, and 5) being ignored at work or being treated like air. Except for age (nurses older than 34 years were 11.5% more likely to encounter bullying than those aged 34 or younger), no significant difference was observed in individual factors between nurses who had and those who had not been bullied, while a significant difference was found for organizational factors. Under democratic leadership, a higher percentage of nurses (5.7%) said they did not encounter workplace bullying, while under autocratic leadership, a higher percentage (12.7%) of nurses experienced bullying. Under bureaucratic organizational culture, a higher percentage (13.8%) of nurses experienced workplace bullying, while there was a higher percentage, 5.4% and 11%, of nurses not encountering bullying working under supportive organizational culture and mixed organizational culture, respectively. There was a difference in the impacts of workplace bullying on personal and organizational outcomes between nurses who had and those who had not been bullied. Nurses with bullying experience displayed higher scores on psychological health variables including suicidal ideation, occupational fatigue and turnover intentions and had lower job satisfaction. The results of univariate logistic regression analysis showed that nurses over 34 years had 1.74 times higher rate of bullying, compared with those aged 34 years or under. An autocratic leadership style resulted in a 3.63-times higher rate of bullying, compared with mixed leadership style. Nurses working in an innovative organizational culture were 1.86 times and those working in a bureaucratic environment were 3.72 times more likely to encounter workplace bullying than nurses whose organizations adopted a model of mixed culture. We used a linear regression analysis to determine the effect of risk factors, such as age, leadership style and organizational culture, and workplace bullying on personal and organizational outcomes and found they have an impact on psychological distress, suicide idea, occupational burnout, intent-to-leave, job satisfaction, and organizational citizenship behavior among nurses, with low Explained variance.
Conclusions: This study provides empirical evidence of workplace bullying among nurses in Taiwan and serves as an important information source for government, healthcare providers and nurse mangers to build a positive working environment in the future.

並列關鍵字

nurses ； workplace bullying ； personality traits ； power distance ； leadership style ； organizational culture ； psychological distress ； suicide idea ； occupational burnout ； intent-to-leave ； job satisfaction ； organizational citizenship behavior

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