工作壓力與社會支持對醫院工作者組織承諾之相關性－以宜蘭縣某區域教學醫院為例

The Study on the Association of Work Stress and Social Support with Hospital Personnel’s Organizational Commitment -Taking a Regional Teaching Hospital in Yilan as an Example

許豪(Hao Hsu)

指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2014年)

https://doi.org/10.6342/NTU.2014.02787

摘要

研究背景與目的
近年來台灣醫院的勞動環境正面臨諸多的挑戰，包含五大專科醫師人力失衡及護理師人力荒等問題，使得醫院管理階層必須透過工作環境的改善以提升員工的向心力與留任意願。醫院從業人員一方面面臨日益增加的外在要求與勞動強度、薪資福利與工作保障等回饋條件卻不如預期的情況下，所承受的工作壓力也比可能較以往更加繁重，而工作者在職場上所獲得的社會支持在過去研究則可被視為調和工作壓力且增進員工承諾感的重要因子。故本研究的主要目的乃在於探討工作壓力與社會支持對於醫院工作者組織承諾的影響性，並瞭解醫院工作者在上述組織社會心理因子的感受概況。

研究方法
本研究以橫斷式的調查方式，以「付出與回饋失衡模式」（Effort-Reward Imbalance Model）壓力量表、工作特質量表（Job-Content Questionnaire）的社會支持構面及組織承諾量表（Organizational Commitment Questionnaire）等測量工具，針對宜蘭縣某區域教學醫院之全體專任員工進行普查，共計回收1,116份有效問卷，回收率達74.15%。

結果與建議
研究結果發現，因「付出與回饋失衡」所產生的工作壓力對於個案醫院工作者的組織承諾感受有顯著的負向影響，而當工作者在此失衡狀態下，若同時合併有「工作過於投入人格」傾向時，將更加危害其對於組織的承諾感受。職場上所感受到的「主管與同事支持」雖然對於其組織承諾有正向的影響，但在「付出與回饋失衡」對於工作者組織承諾的負向損害卻未呈現出顯著的調和效果。
本次研究亦指出個案醫院的職場環境有著相對顯著的付出與回饋失衡的壓力問題，在人員對於醫院的組織承諾感受層面亦有待改善，其中又以護理與專科護理師等兩類人員的情況較為嚴重。另一方面，擔任主管職的人員雖較非主管者有著較高的組織承諾感，但相對也承受著較高工作壓力。
本研究結論顯示個案醫院除了需要積極的監控人員在工作壓力與組織承諾的感受之外，亦必須能夠建構一套有效的預防及因應措施，盡可能排除此類可能危害健康的壓力源，並藉以加強人員的歸屬感與留任意願。

關鍵字

醫院工作者 ； 組織承諾 ； 付出與回饋失衡 ； 工作壓力 ； 社會支持

並列摘要

Background and Purpose:
In recent years, the healthcare labor environment in Taiwan is facing numerous challenges, including the workforce imbalances and manpower shortages among the five major physician specialists and nursing staffs. Therefore, in order to enhance the overall organizational cohesion and the staffs’ intention to stay, the management level of hospitals are required to take additional efforts in improving its personnel’s work environment.
Hospital employees are now under the circumstances of facing a potential mismatch between their work efforts and rewards, while the public demands and work intensity are increasing, the level of compensations, job benefits and securities are still below the employees’ expectation, which in turns are making them to endure a higher level of stress than in the past. Furthermore, in the previous literatures, the level of social supports in the workplace can be characterized as a significant factor in reconciling employees’ work stress and enhancing their commitment to the organization.
Thus, the purpose of this study is to discuss the association of work stress and social support with hospital employee’s organizational commitment, and to grasp a general understanding of the employee’s current status among the three psychosocial factors.

Study Methods:
The study employed a cross-sectional design of survey and subjects are consisted of the full-time employees working in a regional teaching hospital in Yilan county of Taiwan. A structured questionnaire including the Effort-Reward Imbalance Model (ERI), Job-Content Questionnaire (JCQ) and Organizational Commitment Questionnaire (OCQ) is used to collect information on subjects’ work stress, social support and organizational commitment respectively. A total of 1,116 valid questionnaires were completed, the response rate was 74.15%.

Results and Conclusions
The study results indicate that work stress caused by the imbalance between efforts and rewards can have a significant negative impact on hospital employees’ organizational commitment. In addition, a combination of ERI state and tendency of overcommitted to work (i.e., a personality characteristic) will increase the negative impact of work stress upon hospital employee’s organizational commitment. Although the study results showed that social support (i.e., supervisor and coworker support) have a direct positive association with employee’s organizational commitment, the interaction effect of social support and ERI on organizational commitment remained insignificant.
Furthermore, the findings revealed that the case hospital not only has a relatively high ERI prevalence rate, but also its employee’s overall commitment needs to be further improved. Among different types of hospital employees, nursing staffs and advance nursing practitioners (APNs) experienced the highest ERI and lowest overall commitment. Employees with supervisory position on the other hands have a higher commitment towards the hospital, but they tend to endure a relatively higher level of work stress compare to the non-supervisors.
In conclusion, the findings of this study have some contributions to managers of the case hospital. It suggested that the management of the hospital need to take an active role in monitoring its employees’ work stress and organizational commitment, also it must be able to construct an effective response measures in order to prevent the potential health hazards caused by work stress and to enhance its personnel’s overall well-being and intention to stay.

並列關鍵字

Hospital Personnel ； Organizational Commitment ； Effort-Reward Imbalance ； Work Stress ； Social Support

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