以護理師觀點探討病房不同專業照護情境及專業角色認同的相關因素

研究目的全民健保總額預算制度的實施及醫療產業的激烈競爭之下，醫療機構的收入減少，造成各醫療機構的營運日漸困難，為使成本與收支平衡，不斷的發展開源節流因應之經營策略，如:提升病床周轉率等；當病房出現不同科別屬性的流用之現象，導致護理人員每天工作需面對的病人科別數增多、照護情境比以前複雜很多，產生難因應護理工作中的問題，對工作挫折，故引發研究者從護理師觀點來探討護理人員背景因素對病房不同專業照護情境及專業角色認同的相關性。研究方法本研究研究起訖期間：自2015年03月起至2015年05月完成收案，主要以南區區域教學及地區教學醫院職場工作兩年內的臨床護理人員為研究對象，收集有效樣本數為206件，整理出從工作兩年的護理人員「背景因素」在「護理工作價值」及「對不同醫療情境之照護能力的認同」兩個向度，其問卷信度Cronbach’α =0.863，採用SPSS 20.0版進行統計分析。二、研究假設，分述如下： (一)、不同背景的護理師對病房流用政策出現不同照護情境沒有顯著差異。 (二)、在流用病房政策下護理師對醫療執業能力精熟度及護理工作價值有顯著差異。 (三)、在流用病房政策下出現不同照護情境對護理師的專業角色認同相關影響。研究結果在206位新進護理師為有效施測樣本，進行統計相關分析後發現 (一)、在過去有區域醫院工作經驗及工作於內科的護理人員病房出現不同照護情境有顯著差異。 (二)、護理人員單位三科以上科別病房流用對「護理工作價值」及「對不同醫療情境之照護能力的認同」有顯著差異。結論與建議從本研究結果發現，單一病房照護科別屬性出現三科以上會提升進入職場一年內的護理人員挫折，而挫折中對「護理」專業角色逐漸失去，甚至有轉換職場之念頭，而護理人力的流失，在招募和訓練新進人員方面花費之成本與日俱增，並影響醫院營運成本與工作效率，因此建議機構管理者在執行病房流用的政策下，可考慮科別流用數，提升新進人員留任，藉由高度價值觀取向可以有效提高其組織認同與專業認同，創造組織與員工個人生涯路徑選擇雙贏的結果。

關鍵字

護理師；專業角色認同；對醫療照護情境之執業能力精熟度

並列摘要

Purposes Under the fierce competition of the total health care budget for the National System of Implementation and the medical industry, medical institutions reduce revenue, resulting in operating various medical institutions increasingly difficult to make ends meet cost and continuous development and cut costs in response to the business strategy. Such as: lifting bed turnover rate; when there are different phenomena ward divisions with properties of flow, resulting in an increase in the number of nursing staff divisions patients need daily face care situation more complicated than ever before, resulting in difficulty should care because the problem, work frustration, it triggered nurse researcher from viewpoint to explore background factors on the ward nurses specializing in the care of different contexts and professional role identity correlation. Methods During the research study Termini: from March 2015 until May 2015 to complete closing the case, mainly south of the existing area of clinical nursing teaching and regional teaching hospital workplace work within two years of the study, the number of 206 valid samples were collected pieces, sorted out from the nurses 'contextual factors' for two years in the "value care" and "care in different medical situations for the recognition of the ability of" two dimensions, its questionnaire reliability Cronbach'α = 0.863, using SPSS 20.0 for statistical analysis. The study hypothesis, as described below: (A) Different backgrounds nurse on the ward flow occurs with no significant differences in the policy context of care. (B)There are significant differences nurses at ward flow with the policy of Medical Practice ability and mastery of the value of nursing. (C)There are different scenarios under flow with care ward policy nurse professional role identity related impacts. Result After 206 New nurse valid sample, the statistical correlation analysis (A)There are areas of the hospital in the past work experience and work in the medical ward of nursing care there are different scenarios have significant differences. (B)There are significant differences between nurses’ flow units above three subjects used to ward divisions' worth of care "and" care in different medical situations for the recognition of ability. " Discussion and Suggestions Results from this study found that a single ward care divisions attribute appears more than three subjects will ascend into nursing career setbacks within a year, and setbacks for "nursing" professional role gradually lost, and even the idea of converting the workplace, and nursing manpower the loss cost of recruiting and training new staff regard the growing and affect hospital operating costs and work efficiency, and therefore the policy recommendations agency managers in the implementation of the ward stream used may be considered divisions stream with the number and enhance new staff retention, by highly values orientation can effectively improve their organizational identity and professional identity, creating organizational and individual employee career path selection win-win results.