社會與個我取向之成就動機、工作環境因素與投入醫護職場意願關係之研究-以護理科應屆畢業生為例

研究目的：依據2020年3月中華民國護理師護士公會全國聯合會統計僅有59.5%的護理人員願意投入醫護職場，若護理臨床照護人力不足則將影響醫療品質甚鉅。爰此，瞭解護理人員是否願意投入醫護職場，對於紓解臨床照護人力窘迫非常重要。過往研究發現成就動機與職業選擇有關，但較少應用在護理應屆畢業生從事行業之選擇。本研究目的在於探討社會取向成就動機、個我取向成就動機及工作環境因素與護理科系應屆畢業生是否投入醫護職場之關聯性。研究方法：本研究運用余安邦等人提出之「社會取向成就動機」與「個我取向成就動機」理論並參考Lake等人修訂之「護理工作環境量表」，經由學界及實務專家共同參與編纂問卷，各題項內容效度為0.99，經前測信度分析，所有構面之Cronbach's α均在0.8以上，代表其內部一致性具高可信度。以北部某醫護管理專科學校日間部107學年度護理科五年級應屆畢業生為研究對象，於108年5月間進行橫斷式問卷調查，研究者進行說明後由學生自填。並利用SPSS 24.0版進行建置與分析，除單變項分析外，並以羅吉斯回歸進行多變項分析；本研究業經聯新國際醫院人體試驗委員會核准(LSHIRB:19-012-C0)後執行。結果與討論：共發出488份問卷，扣除填答不全或有誤共回收373份（76.4%）為有效問卷。其中女生344位，佔92.2%。所有填答者中共260位（69.7%）選擇畢業後會投入醫護職場，其中以至區域醫院為最多（116位，31.1%）；自認到職後至少可留任2年者為最多（104位，27.9%）。與是否投入醫護職場最有關因素為女性[adjusted odds ratio （aOR）=3.4，p=0.002]，代表女性較男性傾向於畢業後投入醫護職場；與優先投入區域以上醫院有關因素為個我取向成就動機（aOR=1.06，p=0.021），意即個我取向成就動機越高者（代表勇於接受挑戰）與投入照護複雜度較高之場域有關；相較於投入其他職場，與投入醫護職場有關因素為工作環境因素（aOR=1.04，p=0.028），代表工作環境越好（如薪資、升遷條件較好）與投入醫護職場有關；與留任時間有關因素為社會取向成就動機（aOR=1.02，p=0.005），代表社會取向成就動機越高者（即較易受社會意見左右自身想法），自覺到醫護職場後可以久任時間較長。結論：本研究發現社會取向成就動機、個我取向成就動機與工作環境與護理科應屆畢業生是否投入醫護職場之意願、服務醫療院所層級以及自覺可留任時間有關；相關研究可供醫療機構遴聘護理人員之參考。

關鍵字

社會取向成就動機；個我取向成就動機；工作環境因素；護理科應屆畢業生

並列摘要

Purpose: According to the report from Taiwan Union of Nurses Association (TUNA) in March 2020, only 59.5% of nursing staff are willing to enter the nursing workplace. Insufficient nursing manpower inevitably leads to poor quality of medical care. To ease the manpower shortage, it is key to understand whether the nursing staff is willing to enter the nursing workplace. Previous studies have revealed the association between achievement motivation and career choice, but few were focused on the occupational choice for nursing graduates. The aim of this study is to explore the correlation between the nursing graduates’ willingness to enter nursing workplace and social-oriented as well as individual-oriented achievement motivation, and workplace environment. Methods: The questionnaire used in this study was compiled by both academic and practical experts based on the “social-oriented and individual-oriented achievement motivation theory” proposed by An-Bang Yu et al., as well as the “practice environment scale of the nursing work” developed by Lake et al. The validity and reliability of the questionnaire were verified through pilot study. Nursing graduates from a Junior College of Medical Care in Northern Taiwan in 2019 were subjects in this study. A cross-sectional survey of self-reported questionnaire was carried out in May 2019. Data was analyzed by SPSS 24.0, in addition to univariate analysis, logistic regression was performed for multivariate analysis. This study was reviewed and approved by Landseed International Hospital Institutional Review Board (LSHIRB: 19-012-C0). Result and Discussion: A total of 488 questionnaires were sent, and 373 (76.4%) were returned as valid after the exclusion of incomplete or erroneous responses. Among them, 344 (92.2%) were female. 260 (69.7%) respondents chose to enter the nursing workplace, of which regional hospitals ranked first (116, 31.1%); and the most frequent perceived length of retention is at least 2 years (104, 27.9 %). The most relevant factor to the decision of entering the nursing workplace is gender [adjusted odds ratio (aOR) =3.4, p=0.002], indicating that when compared to male, female preferred to enter nursing workplace after graduation. Individual-oriented achievement motivation is the factor correlated to enter regional or higher level hospitals as first priorities (aOR=1.06, p=0.021), suggesting that higher individual-oriented achievement motivation (willing to take the challenge) is correlated to entering the workplace with higher medical care complexity. As compared to other workplaces, the workplace environment is correlated to the entry to nursing workplace (aOR=1.04, p=0.028), suggesting that better workplace environment (such as better salary and promotion possibilities) is related to the employment in the nursing workplace; Social-oriented achievement motivation is related to the perceived retention time (aOR=1.02 , P=0.005), suggesting that those with higher social-oriented achievement motivation (those tend to achieve externally determined goals in a socially desirable way) have longer perceived retention in nursing workplace. Conclusion: This study found that social-oriented achievement motivation, individual-oriented achievement motivation and working environment are associated with the willingness of nursing graduates to enter the nursing workplace, the level of hospital preferred and the perceived retention time. Our study can serve as a reference for the recruitment of nursing staff by medical institutions.