中國大陸西部地區護理工作環境與護理人員職業倦怠、工作滿意度及離職意向的相關性研究

Correlation between Nursing Work Environment and Nurse Burnout, Job Satisfaction, and Turnover Intention in the Western Region of Mainland China

10.6224/JN.63.1.87

陳雨朦(Yu-Meng Chen)；方進博(Jin-Bo Fang)

護理工作環境 ； 職業倦怠 ； 工作滿意度 ； 離職意向 ； nursing work environment ； burnout ； job satisfaction ； turnover intention

護理雜誌

63卷1期（2016 / 02 / 01）

87 - 98

繁體中文

背景　護理人員的職業倦怠、工作滿意度低會導致離職，如果能改善護理工作環境則可降低護理人員的職業倦怠、提高工作滿意度，也可降低護理人員的離職意向。目的　探討護理工作環境與護理人員職業倦怠、工作滿意度及離職意向之關係。方法　本研究採橫斷式描述性設計，針對2012年2月至2012年12月間中國西部地區某省20所醫院的83個內外科重症病房的1,112名臨床護理人員為對象，採多階段抽樣方式選取所有護理人員。研究工具為中文版之護理工作環境指標量表、Maslach倦怠量表、工作滿意度量表及自擬的護理人員基本屬性和離職意向等。本研究資料採統計軟體SPSS 19.0進行統計分析，檢驗水準為.05。結果　在護理工作環境五個構面中，醫護合作關係平均值最高（3.57 ± 0.68；總分= 4分），而充足的人力和物力則最低（3.21 ± 0.82）。在護理人員中，經歷高度倦怠者有103人（占9.5%），其所包涵的三個構面中經歷過高度倦怠者分別為情感耗竭635人（58.4%）、去人格化491人（45.2%）和個人成就感267人（24.6%）。護理人員對目前工作的滿意度為59%，有3.8%的護理人員有離職意向。在評價為好的護理工作環境中，護理人員職業倦怠與離職意向發生之風險比值（OR值）低於評價為差的護理工作環境，而工作滿意度則高於評價為差的護理工作環境，其OR值分別為情感耗竭0.64、去人格化0.66、個人成就感0.57、離職意向0.19和工作滿意度2.26。結論／實務應用　從研究結果可知護理工作環境會影響護理人員的職業倦怠、工作滿意度和離職意向，因此建議護理管理者應積極建構優質的護理工作環境。

Background: Nurse burnout and low job satisfaction are main reasons that cause nurses to leave their current position. Improving the nursing work environment may reduce the severity of job burnout and of job dissatisfaction and thus decrease the turnover intention of nursing staff. Purpose: The aim of this study was to explore the correlation between the nursing work environment and the outcome variables of burnout, job satisfaction, and turnover intention in the western region of Mainland China. Methods: This is a cross-sectional descriptive study. Survey data were collected between February and December 2012 from 1,112 clinical nurses working at 83 medical, surgical, and intensive care units in 20 hospitals across the western region of Mainland China. Multistage sampling was conducted on some of the participants. The research instruments that were used included the Practice Environment Scale of the Nursing Work Index, Maslach Burnout Inventory, Nurse Job Satisfaction Scale, and the self-developed basic information and turnover intention questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 19.0. The level of statistical significance was set at p ＜ .05. Results: Among the five dimensions of the nursing work environment, collegial nurse-physician relations earned the most favorable mean scores (3.57 ± 0.68; total = 4 points), whereas adequacy of staffing and resources earned the lowest (3.21 ± 0.82). Over half of the participants (58.4%) reported experiencing a high level of emotional exhaustion (EE) burnout, 45.2% reported experiencing a high level of depersonalization (DP) burnout, and 24.6% reported experiencing a high level of personal accomplishment (PA) burnout. About 59% of the participants were satisfied with their work and 3.8% reported intention to leave. Participants in self-reported ＂favorable＂ work environments were less likely to report high burnout, less likely to report intention to leave, and more likely to report job satisfaction than their peers in self-reported ＂poor＂ work environments. The odds ratio (OR) values were 0.64 (EE), 0.66 (DP), 0.57 (PA), 0.19, and 2.26. Conclusions / Implications for Practice: The results of the present study support that the nursing work environment affects nurse burnout, job satisfaction, and turnover intention. Therefore, nursing managers should work to improve nursing work environments in order to reduce the turnover intent among their nursing staff.

1. 中華人民共和國衛生部（2013）．2013中國衛生統計年鑒．取自http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2013/index2013.html [Ministry of Health of P. R. China. (2013). 2013 China health statistics yearbook. Retrieved from http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2013/index2013.html]
2. Aiken, L. H.,Clarke, S. P.,Sloane, D. M.(2002).Hospital staffing, organization, and quality of care: Cross-national finding.International Journal for Quality in Health Care,14(1),5-14.
3. Aiken, L. H.,Clarke, S. P.,Sloane, D. M.,Lake, E. T.,Cheney, T.(2008).Effects of hospital care environment on patient mortality and nurse outcomes.The Journal of Nursing Administration,38(5),223-229.
4. Aiken, L. H.,Sermeus, W.,Van den Heede, K.,Sloane, D. M.,Busse, R.,McKee, M.,Kutney-Lee, A.(2012).Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.BMJ: British Medical Journal,344,e1717.
5. Buchan, J.,Aiken, L.(2008).Solving nursing shortages: A common priority.Journal of Clinical Nursing,17(24),3262-3268.
6. Carthon, J. M. B.,Lasater, K. B.,Sloane, D. M.,Kutney-Lee, A.(2015).The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: A cross-sectional study of US hospitals.BMJ Quality & Safety,24(4),255-263.
7. Choi, J.,Boyle, D. K.(2014).Differences in nursing practice environment among US acute care unit types: A descriptive study.International Journal of Nursing Studies,51(11),1441-1449.
8. Estryn-Béhar, M.,Van der Heijen, B. I. J. M.,Ogińska, H.,Camerino, D.,Le Nézet, O.,Conway, P. M.,the NEXT Study Group(2007).The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses.Medical Care,45(10),939-950.
9. Friese, C. R.,Lake, E. T.,Aiken, L. H.,Silber, J. H.,Sochalski, J.(2008).Hospital nurse practice environments and outcomes for surgical oncology patients.Health Services Research,43(4),1145-1163.
10. Heinen, M. M.,van Achterberg, T.,Schwendimann, R.,Zander, B.,Matthews, A.,Kózka, M.,Schoonhoven, L.(2013).Nurses' intention to leave their profession: A cross sectional observational study in 10 European countries.International Journal of Nursing Studies,50(2),174-184.
11. Khamisa, N.,Oldenburg, B.,Peltzer, K.,Ilic, D.(2015).Work related stress, burnout, job satisfaction and general health of nurses.International Journal of Environmental Research and Public Health,12(1),652-666.
12. Kramer, M.,Hafner, L. P.(1989).Shared values: Impact on staff nurse job satisfaction and perceived productivity.Nursing Research,38(3),172-177.
13. Kutney-Lee, A.,Wu, E. S.,Sloane, D. M.,Aiken, L. H.(2013).Changes in hospital nurse work environments and nurse job outcomes: An analysis of panel data.International Journal of Nursing Studies,50(2),195-201.
14. Kwak, C.,Chung, B. Y.,Xu, Y.,Eun-Jung, C.(2010).Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: A questionnaire survey.International Journal of Nursing Studies,47(10),1292-1298.
15. Lake, E. T.(2002).Development of the practice environment scale of the nursing work index.Research in Nursing & Health,25(3),176-188.
16. Laschinger, H. K. S.(2008).Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: Further testing the nursing work life model.Journal of Nursing Care Quality,23(4),322-330.
17. Li, B.,Bruyneel, L.,Sermeus, W.,Van den Heede, K.,Matawie, K.,Aiken, L.,Lesaffre, E.(2013).Group-level impact of work environment dimensions on burnout experiences among nurses: A multivariate multilevel probit model.International Journal of Nursing Studies,50(2),281-291.
18. Liu, K.,You, L. M.,Chen, S. X.,Hao, Y. T.,Zhu, X. W.,Zhang, L. F.,Aiken, L. H.(2012).The relationship between hospital work environment and nurse outcomes in Guangdong, China: A nurse questionnaire survey.Journal of Clinical Nursing,21(9-10),1476-1485.
19. Maslach, C.,Jackson, S. E.,Leiter, M.(1996).The Maslach burnout inventory manual.Palo Alot, CA:Consulting Psychologists Press.
20. Nantsupawat, A.,Srisuphan, W.,Kunaviktikul, W.,Wichaikhum, O.-A.,Aungsuroch, Y.,Aiken, L. H.(2011).Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.Journal of Nursing Scholarship,43(4),426-432.
21. Numminen, O.,Ruoppa, E.,Leino-Kilpi, H.,Isoaho, H.,Hupli, M.,Meretoja, R.(2016).Practice environment and its association with professional competence and work-related factors: Perception of newly graduated nurses.Journal of Nursing Management,24(1),E1-E11.
22. Patrician, P. A.,Shang, J.,Lake, E. T.(2010).Organizational determinants of work outcomes and quality care ratings among army medical department registered nurses.Research in Nursing & Health,33(2),99-110.
23. Simoens, S.,Villeneuve, M.,Hurst, J.(2005).OECD health working papersOECD health working papers,Paris, France:Organization for Economic Cooperation and Development.
24. Sousa-Poza, A.,Henneberger, F.(2004).Analyzing job mobility with job turnover intentions: An international comparative study.Journal of Economic Issues,38(1),113-137.
25. Van Bogaert, P.,Meulemans, H.,Clarke, S.,Vermeyen, K.,Van de Heyning, P.(2009).Hospital nurse practice environment, burnout, job outcomes and quality of care: Test of a structural equation model.Journal of Advanced Nursing,65(10),2175-2185.
26. Van der Heijden, B. I. J. M.,Kümmerling, A.,van Dam, K.,van der Schoot, E.,Estryn-Béhar, M.,Hasselhorn, H. M.(2010).The impact of social support upon intention to leave among female nurses in Europe: Secondary analysis of data from the NEXT survey.International Journal of Nursing Studies,47(4),434-445.
27. Zhang, L. F.,You, L. M.,Liu, K.,Zheng, J.,Fang, J. B.,Lu, M. M.,Bu, X. Q.(2014).The association of Chinese hospital work environment with nurse burnout, job satisfaction, and intention to leave.Nursing Outlook,62(2),128-137.
28. 王珊珊、劉彥慧(2012)。護士職業倦怠與自我效能和工作環境的相關及回歸分析。中華行為醫學與腦科學雜誌，21(6)，549-551。
29. 王富華、徐玲、謝錚、張拓紅(2013)。我國臨床醫生職業倦怠的區域分佈現狀分析。中國全科醫學，16(9)，3006-3008。
30. 王應強、韋詩友、李幼平、鄧紹林、羅倩倩、李琰(2013)。中國護理學科發展面臨的挑戰與應對策略。中國循證醫學雜誌，13(2)，128-136。
31. 王麗、李樂之(2011)。中文版護理工作環境量表的信效度研究。中華護理雜誌，46(2)，121-123。
32. 束翠華、熊正香、李麗(2012)。臨床護士離職意願影響因素的研究進展。護理管理雜誌，12(1)，47-49。
33. 李一明、余紅梅、馮榮梅、何潔珺(2009)。中山大學大型綜合醫院護士工作滿意度調查分析。中山大學學報（醫學科學版），30(z2)，110-112。
34. 李永鑫、李藝敏(2007)。護士倦怠與自尊、健康和離職意向的相關性研究。中華護理雜誌，42(5)，392-395。
35. 肖保娟、劉可、尤黎明、張利峰、馬莉、王磊、鄭晶(2012)。我國二、三級醫院護士工作疲潰感狀況的調查分析。護理學雜誌，27(24)，64-67。
36. 段艮芳、何海豔、何燕、周萬明(2014)。某市三級醫院臨床護士工作滿意度對離職意願的影響。中國衛生事業管理，10，746-749。
37. 張洪福、劉彥慧、楊洋、劉璟瑩(2015)。在職護士離職傾向相關因素分析。中華護理雜誌，50(2)，155-160。
38. 許瑩、尤黎明、劉可、馬偉光、王紅紅、方進博、朱曉雯(2011)。我國醫院護理人力資源流失現狀研究。中國護理管理，11(9)，29-32。
39. 馮鶯、駱宏、葉志弘(2004)。MBI量表在護士工作倦怠研究中的測試。中國心理衛生雜誌，18(7)，477-479。

1. Yuan LI,Jinbo FANG,Chunfen ZHOU(2019).Work-Related Predictors of Sleep Quality in Chinese Nurses: Testing a Path Analysis Model.The Journal of Nursing Research,27(5),1-10.
2. 劉明莉,曹英,林雅蘋(2023)。工作環境對護理人員職業倦怠與留任意願的中介效果。護理雜誌，70(4)，36-46。
3. 盧雅惠,蔡忠融(2023)。地區醫院專科護理師職業倦怠、工作滿意度與離職意向探討。勞動及職業安全衛生研究季刊，31(3)，32-47。
4. 楊曉鏵,張伊雯,洪毓欣,李歡芳(2021)。疲潰概念分析。精神衛生護理雜誌，16(1)，27-34。