工作特性、專業承諾及工作績效之相關性探討-以血液透析室及內科病房護理人員為例

The relationships among job characteristics, professional commitment and job performance– the case of nursing staff in dialysis units and medical wards

許菀齡(Wan-Ling Hsu)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00053

摘要

目的:自從1995年全民健康保險制度實施後，促使醫院更須注重工作績效以提升競爭力，由於護理人員是醫療團隊中人數最多的一群，約佔醫療人力的40~60%，也因此更突顯如何提升護理人員工作績效之重要性，而影響工作績效之相關因素更值得探討。本研究旨在了解血液透析室及內科病房護理人員之工作特性差異對專業承諾及工作績效之影響，同時檢驗專業承諾在工作特性與工作績效間之中介效果。

方法:採便利取樣方式，針對北部、中部及南部十家醫院之血液透析室及內科病房護理人員進行問卷調查。研究工具係根據工作特性指標（JCI）之六個構面、Motowidlo 與 van Scotter 提出之工作績效二個構面進行問卷修訂，專業承諾量表則採用呂桂雲發展的結構式問卷。資料經過整理後，進行描述性統計、獨立樣本t 檢定、變異數分析、Pearson 相關分析、多元迴歸分析。

結果:問卷共計發出446份，有效問卷為357份（80.04%）。其中血液透析室佔226人（63.3%），一般內科病房131人（36.7%）。結果發現：（1）整體工作特性平均得分為3.73分，為中高分數，又以內科病房（3.81）的工作特性高於血液透析室（3.68）。整體專業承諾與工作績效平均得分別為2.74分、4.03分，二者皆為血液透析室（2.74、4.09）得分高於內科病房（2.73、3.92）。（2）血液透析室與內科病房之整體工作特性（t=-3.005，p<0.01）有顯著差異，以內科病房大於血液透析室。（3）血液透析室與內科病房之整體工作績效（t=2.960，p<0.01）有顯著差異，以血液透析室大於內科病房。（4）三變項皆有相關性，又以專業承諾與工作績效之相關性最高（r=0.516）。（5）以工作特性中工作變化性（β=0.302，p<0.001）、工作回饋性（β=0.128，p <0.05）構面、專業承諾中價值認同（β=0.456，p<0.001）構面對工作績效有顯著之影響力。（6）以專業承諾為中介變項進行檢定發現，加入專業承諾會降低工作特性對工作績效之影響力，β值由原來0.490（p<0.001）降至0.336（p<0.001），因此專業承諾對工作特性與工作績效間有部分中介效果。

結論:血液透析室與內科病房之工作特性、專業承諾與工作績效皆有顯著之相關性，其中又以工作變化性、工作回饋性及專業價值認同對工作績效有顯著之正向影響。護理工作特性以內科病房高於血液透析室，工作績效則反之。因此，建議醫院管理者應針對病房護理工作進行檢視，可藉由資訊系統整合減少常規性之工作，增加單位護理活動之多元性設計，提供完善之輪訓（輪調）措施，並建立良好晉升管道及工作考核機制，以提高護理人員對工作回饋性感受，並提昇護理人員專業價值的認同與投入，進而提高醫院之生產力。

關鍵字

工作特性 ； 專業承諾 ； 工作績效 ； 血液透析室 ； 內科病房

並列摘要

Objectives:After the implementation of National Health Insurance program in 1995, hospitals have been more concerned about operational performance so as to attain a competitive advantage. Since nursing staff comprises 40% to 60% of health care manpower in hospitals, it is worthwhile to explore how to enhance nursing staff job performance. The aim of this study was thus to clarify the association of job characteristic, professional commitment, and job performance of nursing staff in dialysis unit and medical ward. Another aim was to investigate the mediating effect of professional commitment between job characteristic and job performance.

Methods:A convenient sampling approach survey was conducted for this study. Nursing staff working in dialysis units or medical wards from 10 conveniently selected hospitals located in the northern, central, and southern Taiwan were the targeted population. The questionnaire comprises the adapted six dimensions of Job Characteristics Index (JCI), the Motowidlo and Scotter’s job performance inventory, and an assessment instrument of professional commitment. Data were analyzed with the aid of statistical software package SPSS to provide descriptive statistics, t -test, ANOVA, Pearson correlation, and multiple regression modeling.

Results:Of the 446 nurses surveyed, 357 (a response rate of 80.04%) responded with 226 (63.3%) from dialysis units and 131 (36.7%) from medical wards. Overall, the average score for job characteristic was 3.73 (on a 5-point scale) indicating a mid-level assessment and nurses from medical wards had a higher average score than those from dialysis units (3.81 vs. 3.68). The average score for professional commitment and job performance was 2.74 (out of 4) and 4.03 (out of 5), respectively. Further, nurses from dialysis units had higher scores (2.74, 4.09) than those from medical wards (2.73, 3.92). The scores of job performance reached a significant difference (t=2.960，p<0.01). Besides, there existed significant correlations among job characteristic, job performance, and professional commitment, with a relatively higher level of correlation between professional commitment and job performance (r= 0.516). The dimensions “skill variety” (β=0.302, p<0.001) and “task feedback” (β=0.128, p <0.05) of JCI, and “belief in goals and values” (β=0.456, p<0.001) of professional commitment were significant predictors of job performance. The professional commitment revealed a partial mediating effect between job characteristic and job performance.

Conclusions:The average score of job characteristic for medical wards was higher than that for dialysis units; to the contrary, dialysis units had higher job performance scores than their counterparts. It is suggested that hospital administrators should conduct a thorough job analysis on nursing care activities and develop effective information systems to eliminate inefficient routine tasks. Besides, increasing the variety of nursing activities, designing a better job rotation system, and establishing a well-recognized promotion and evaluation mechanism might help enhance the perception of job feedback for nursing staff. It is expected that through these efforts nursing staff would increase their professional commitment and job involvement, which in turn would improve hospital operational performance.

並列關鍵字

Job characteristic ； Professional commitment ； Job performance ； Dialysis unit ； Medical ward

參考文獻

王靜琳、蔡來蔭、呂桂雲（2005）。專業承諾之概念分析。護理雜誌，52（5），71-77。

呂桂雲、邱香蘭（1998）。護生專業承諾之研究。護理研究，6（2），109-120。

呂桂雲、張永源、邱香蘭（2001）。專科畢業護理人員護理專業承諾改變之研究。護理研究，9（1），28-38。

胡庭禎（1999）。組織承諾與專業生涯承諾之探討-以護理人員為例。弘光學報，33，1-13。

潘依琳、張媚（1998）。醫院護理人員之工作特性、成就動機對工作投入、工作滿足、與留職意願之影響。中華衛誌，17（1），48-58。