獨輪上的領導-基層護理領導的困境與挑戰

Leaders on A Running Unicycle- the Difficulties and Challenges of Head Nurses in Leadership

陳世珍(SHIH-CHEN CHEN)

指導教授 ： 丁姵元

中原大學/商學院/企業管理研究所/碩士(2013年)

https://doi.org/10.6840/cycu201300688

摘要

近幾年來，醫療界人力流失現象開始為民眾所關注，而其中，在醫療產業工作者中佔了最大比例的護理人員尤甚，以政府及公會所公佈的數據顯示，領有執照的護理人員中僅不到六成的人員真正投身於護理照謢作業，而每年由醫療院所離開的護理人員，離職率達到了20%以上，在投入少而流失多的狀況下，醫療產業的疾病照謢環節開始產生了警訊。
在護理人員相關文獻中指出，護理工作量的繁複、疾病照謢壓力及工作與家庭需求的拉扯等往往造成了護理人員的離開。而於此狀況之下，身為直接面對護理人員的護理長而言，在護理單位的穩定與運作順暢上，扮演了重要的角色。但綜觀各學者的研究多以人員留任、離職相關議題進行探討，或以量化方式進行護理人員壓力源探究並進行分類統計，少有以護理長角度進行深入瞭解，因此，本研究的研究目的在於探討以護理長角度在面對大環境的護理人力短缺狀況下，在單位的領導上所面臨的困境與挑戰以及所因應的相關作為，並以質性研究的方法，藉由與護理長們的訪談，以取得較為深層人員面與體制面等相關資料，由了解與護理人員的互動、應對與管理等層面，從單位的領導者角度，進一步瞭解護理人員的管理與所面臨的困境與挑戰。
本研究發現，醫療照謢具有強烈的團隊性，在護理照謢領域，多以人員間的共同合作以達到完善的疾病照謢目的，所有的成員和角色間的關係緊密，也因此，透過研究發現，分析歸納後的護理長的挑戰與困境，以來自於人員面的相關問題為最大宗，追溯其源頭從新進人員的基本素質開始，問題即已產生，並演變為後續一連串的人力缺口引發工作壓力增加、工作負荷加重、人員衝突產生等效應。而在產業特性面，因護理照謢工作的全年無休與輪班狀況，致使護理人員在工作與家庭面產生了拉扯，而成為了人員離職的潛伏因素。在工作負荷與工作壓力下，護理人員對於人員訓練與主管人才培育產生了排斥，致可能因此造成護理照謢工作的人才培育斷層產生。而種種現象首當其衝者為身為單位領導者的護理長，最終導致的將會是ㄧ個疲於奔命無法歇息以至最後選擇離去的護理長，如此而醫療產業的護理照謢環節將大受影響。

關鍵字

領導 ； 護理長 ； 困境 ； 挑戰

並列摘要

In recent years, common individuals have begun paying close attention to the phenomenon of the loss of human resources in the medical industry; this is particularly reflected in the loss of nursing personnel, who form the maximum number of workers engaged in the medical industry. According to data publicised by the government and labour unions, less than 60% of all licensed nursing personnel are sincerely devoted to the nursing field, whereas the rate of quitting medical-related organisations among nursing personnel is approximately more than 20%. Therefore, because of a decrease in the number of individuals joining this profession and increase in incidences of quitting, warning signs related to the nursing sector have appeared in the medical industry.
Based on literature related to nursing personnel, factors including heavy and complicated workload, pressures of nursing the diseased and the demand of maintaining a balance between work and family are the common reasons for nursing personnel to quit. The individual who is directly related to nursing personnel, particularly the head of the nursing department, plays an important role in maintaining stability and smoothness of the nursing unit operations under such circumstances. In general, researches have mostly discussed subjects related to nursing personnel who continue working and those who resign or explored and collected statistics regarding factors causing stress among nursing personnel by quantitative methods. However, they have seldom thoroughly discussed issues from the perspective of the head of the nursing department. Therefore, the purpose of this research was to discuss the difficulties and challenges faced by the leaders of nursing units as well as their corresponding actions, from the point of view of the head of the nursing department. This was possible by interviewing heads of the nursing department and conducting qualitative researches under the circumstance of a shortage of nursing personnel in the medical industry. Through aspects related to interaction, response and administration of the nursing personnel, we obtained extensive information related to them as well as the systems and gained further knowledge regarding administration, difficulties and challenges that a nursing personnel faces from the point of view of leaders of the units.
According to this research, a strong team spirit was observed among personnel in the medical-care industry. In the nursing field, the purposes of care during disease are mostly realised through co-operation among personnel, and a close relationship between all personnel and their roles was observed. In addition, through research it was observed that challenges and difficulties faced by the head of the nursing departments are mostly caused by relevant personnel problems. Its origin can be traced back to the basic qualities of newcomers; problems have already appeared and developed into a series of follow-up events, including increase in work pressures and workload and interpersonal conflicts caused by the lack of human resources. With regard to the nursing industry features, because of the relentless nature of year-round workload and shift conditions, an imbalance between their work and family occurs, thereby becoming a hidden factor for causing personnel to quit. Under the workload and working pressure, the nursing personnel rejected to accept personnel trainings and director cultivation activities, so talent cultivation faults might be caused in the nursing work. The head of the nursing department, as a leader of the unit, is the first to be affected by these phenomena; therefore, he/she may eventually quit because of exhaustion from continuously managing operations of the nursing department. In the long run, the nursing sector will be markedly affected by this.

並列關鍵字

challenge ； difficulty ； leader ； head of the nursing department

參考文獻

吳宗佑（2008）。主管威權領導與部屬的工作滿意度與組織承諾:信任的中介歷程與情緒智力的調節效果。本土心理學研究，30，3-63。

林竝聖（2011）。醫院形象定位之研究-以桃園縣六家區域醫院為例。台北醫學大學醫務管理學研究所碩士論文。

高靖秋（2011）。臺灣護理人力面面觀。澄清醫護管理雜誌，7(3)，41-46。

張天雄（2012）。報業中階主管在新媒體時代所面對的知能困境研究。創新與管理，9(2)，151-184。

劉和禎（2011）。護理主管的組織公平與護理人員的工作滿足及工作績效之研究。中台科技大學護理研究所碩士論文。