醫療機構護理人員留任意願之研究─以某宗教醫院為例

Nursing Staffs' Willingness of Job Retention-A Case Study on A Religious Hospital in Taiwan

喬麗華(Li-Hua Chiao)

指導教授 ： 蘇彩足

國立臺灣大學/社會科學院/政治學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201703255

摘要

護理人力長期不足、流動率高，是目前臺灣醫療界非常普遍的情形，而根據過去專家的研究，護理人員的流動率高的主要原因，與其生理暨心理需求未獲滿足有關。Maslow需求層次理論將人的需求分為六個層次，其中第五層次及第六層次分別為自我實現需求（Self-actualization needs）及超越自我實現之需求（Over-actualization needs），很多學者專家指出如果在職場上注入職場精神力，能為職場同仁帶來一些靈性的力量，或可提升自我實現及超越自我實現的需求。宗教型醫院通常也會輔以醫療人文教育，藉此來提升靈性之滿足感，但所推動的醫療人文教育是否能將護理的工作價值提升，進而影響護理人員的留任意願？故本研究試以Maslow需求層次理論的六個層次為基礎來設計問卷，於某宗教醫院發759份問卷，回收741份，回收率97.6%，對編制於個案醫院護理部下之臨床護理人員進行問卷調查，期以問卷調查法來了解護理人員在不同的需求層次之工作的滿意度及醫療人文教育兩方面，對於護理人員的留任意願是否有相關。本研究再以參與觀察法及深度訪談法，以立意抽樣的方式，與具長年經驗與護理人員工作最息息相關並長期關注護理人員之醫師進行訪談，另也訪談護理人員及準備離職的護理人員，直接了解護理人員本身的問題、離職的原因及留任的對策。
研究結果發現，問卷調查以生理需求的滿意度明顯偏低(薪資與工作負擔)，愛與隸屬需求之滿意度為最高(單位間的合作和跨單位間的合作)；在護理人員人口屬性與Maslow的各需求層次之關係，無論在護理總年資或醫院年資，多以1年以內及10年以上護理人員之滿意程度，高於3-5年及5-10年者。在護理人員人口屬性與醫療人文教育之關係，或與留任意願之關係，不論是護理總年資或醫院年資，也是以1年以內及10年以上護理人員之滿意程度，高於3-5年及5-10年者。以皮爾森相關分析，進行Maslow的各需求層次、醫療人文教育與留任意願之相關性分析，留任意願與生理需求、安全需求、愛與隸屬需求、自尊需求構面呈現中度正相關；與自我實現需求、超越自我實現需求及醫療人文教育呈現高度正相關。
從深度訪談中了解，多數人認為護理人員離職原因與婚姻或家庭因素有關；職場的氣氛為第二位；工作的成就感是第三位。受訪者的改善策略中，多數人建議以心靈的激勵來提昇護理人員的留任願意；其次是提供升學和進修的彈性；第三為減少工作負荷及提升薪資。
本研究發現Maslow的需求層次理論，生理需求的部分並不是離職原因的第一位，而自我實現需求、超越自我實現需求，如：成就感和工作夥伴的環境氣氛是最重要的因素。本研究也發現，個案醫院在醫療人文教育方面推動各項相關活動，如：迎心傳愛新人營、偏鄉醫療、志工服務、全人醫療的教育及往診等所產生的效應，可啟動護理人員靈性力量，有潛移默化的效果。
本研究建議，在護理人員留任措施方面，提供部分護理正常班制、提供紮實的新人基礎教育訓練、營造在職進修終身學習的工作環境、量身打造設定晉升目標、加強臨床教師、護理長的溝通技巧、設立助學貸款以助於提升護理人員的留任。在醫療人文教育方面，將訓練調整為公假下的必要教學活動、適當時數的醫療人文教育、為不同年資之護理人員設計不同的教育訓練課程（尤其是針對年資3-5年及5-10年之族群）可以更容易讓護理接受。

關鍵字

護理人員 ； 留任意願 ； 留任措施 ； 宗教醫院 ； 醫療人文 ； Maslow需求層次理論

並列摘要

The long-term shortage of nursing manpower and high turnover rate is a very common situation in Taiwan medical industry. According to the experts the main reason for the high mobility of nursing staff is related to their physiological and psychological needs. Maslow's theory of demand hierarchy divides people's needs into six levels, among which the fifth and sixth levels are needs of Self-actualization and the needs of Over-self-actualization. Many scholars pointed out that if infusing the occupational spirit to the workplace would bring up some spiritual power for colleagues. Religious hospitals are often supplemented by medical humanities education to enhance the spiritual satisfaction, but the promotion of medical humanities education can improve the value of nursing staff work and thus affect the nursing staff’s willingness to stay? Based on Maslow Demand theory of the six levels to design the questionnaire, in a religious hospital issued 759 questionnaires, recovery of 741 copies, recovery rate of 97.6%. In the case study hospital clinical units conducted a questionnaire survey. To understand the nursing staff’s satisfaction of the work in the different levels of demand and medical humanities education in the retention of nursing staff are relevant. In this study, supplement to the survey method of participate in observation and in-depth interview also applied to this study. With the conception of sampling to interviewed physicians who were most concerned with the work of nursing staff and interviewed nursing staff and nursing staff who were ready to leave, a direct understanding of the nursing staff's personal problems, the reasons for leaving and the retention measures.
The questionnaire survey showed that the satisfaction rate of the physiological needs was significantly lower (the salary and the burden of work), the satisfaction rate of “the love and the affiliated demand” was the highest (the cooperation in the units and the cooperation across the units); in the nursing staff demographic attributes and Maslow's relationship with the needs of the level regardless of the seniority and the years worked at the case study hospital, the satisfaction of nursing staff worked less than 1 year and more than 10 years higher than 3-5 years and 5-10 years. The relationship between the demographic attributes of nurses and medical humanities education, or the relationship between the demographic attributes of nurses and the willingness to stay, regardless of the seniority and the years worked at the case study hospital, the satisfaction of nursing staff worked less than 1 year and more than 10 years higher than 3-5 years and 5-10 years as well. In the Pearson correlation analysis, the correlation between Maslow's demand level, medical humanities education and retention intention is expressed. The willingness to stay is moderate positively correlated with physiological needs, safety requirements, “love and affiliated needs” and self-esteem demand. The needs of Self-actualization, the needs of Over-self-actualization and medical humanities education showed a high degree of positive correlation.
　　From the in-depth interviews to understand that most people first think that the reasons for nursing staff leaving their jobs are marriage or family factors; reasons related to the workplace atmosphere is the second place; sense of accomplishment is in 3rd place. In the improvement strategies of the respondents, most people suggested that the spiritual incentive to enhance the retention of nursing staff; followed by the flexibility in providing further studies and training; third to reduce the workload and raise monetary reward.
This study found that Maslow's demand hierarchy theory, the physiological needs is not the first reason for leaving the job, the needs of Self-actualization and the needs of Over-self-actualization such as: a sense of accomplishment and working environment is the most important factor. The study also found that the case study hospital in the medical humanities education promoted the relevant activities, the subtle effects of Newcomer’s Love camp, Rural area medical care, Volunteer services, the Full person medical care and the Outreach medical care, etc. might activated nurse staff’s spiritual power. This study suggests that, in the case of nursing staff retention measures, provide some of the regular day shift system, provide a solid new basic education and training, to cultivate a working environment for lifelong learning; tailored a promotion path; to strengthen the communication skills of clinical instructors and head nurse; fund a further study loans are to improve the retention of nursing staff. In the area of medical humanities education, it is recommended to adjust the training as the necessary teaching activities under the official leave, the appropriate hours of medical humanities education, tailor different educational programs for different groups (especially for the groups of 3-5 years and 5 - 10 years worked in the case study hospital) would be easier accepted by nursing staff.

並列關鍵字

nursing staff ； willingness for retention ； retention measures ； religious hospital ； medical humanities education

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