組織氣候和領導型態對護理人員專業能力進階意願影響之研究

Influence of Organizational Climate and Leadership on Nurses' Willingness to Participate in the Nursing Clinical Ladder System

10.6142/VGHN.202106_38(2).0007

陳姵君(Pei-Chun Chen)；龔建吉(Chien-Chi Kung)；許哲瀚(Che-Han Hsu)；黃薏媛(Yi-Yuan Huang)；葉麗月(Li-Yueh Yeh)；洪弘昌(Hung-Chang Hung)

組織氣候 ； 領導型態 ； 專業能力進階意願 ； organizational climate ； leadership ； willingness to nursing clinical ladder

榮總護理

38卷2期（2021 / 06 / 01）

165 - 174

繁體中文

護理人員專業能力進階制度，可以提升護理專業發展及留任意願，雖推行長久，但護理人員參與意願並不高，此現象值得探究。護理主管有效的領導型態可以引領護理人員意向創造和諧組織氣候，進而提高護理人員參與專業能力進階動機，因此本研究從組織氣候及領導型態的角度探討護理人員專業能力進階意願。本研究為橫斷式研究，採方便取樣，研究對象以某區域教學醫院有職業登記之297位護理人員來進行普查，共發放297份問卷，回收277份。結果顯示：一、有進階經驗、最高級階年資淺，較有意願參加能力進階；二、組織氣候與專業能力進階意願呈顯著正相關（r=.60, p＜.001）、領導型態與專業能力進階意願呈顯著正相關（r=.50, p＜.001）、組織氣候與領導型態呈顯著正相關（r=.77, p＜.001）；三、與護理人員專業能力進階意願有顯著相關者為績效標準（β=.32, p＜.001）、轉換型領導（β=.19, p＜.01）、獎酬（β=.25, p＜.001），且績效標準、轉換型領導與獎酬，共可以解釋40.6%的變異量。由此可證實組織氣候與領導型態對於能力進階意願之影響性，建議護理主管除了積極向醫院建言將進階與績效制度結合外，也可以彈性應用不同管理型態營造正向組織氣候，以提升基層護理人員參與進階申請之意願。

The Nursing Clinical Ladder (NCL) system can enhance the development of nursing profession and nurse retention. Although this system has been implemented for a long time, the willingness of nurses to participate has been low. Effective leadership by nursing supervisors can result in a harmonious organizational climate that can, in turn, make nursing staff more willing to participate in the NCL system. Therefore, this study explored the relationships between the willingness of nursing staff to participate in the NCL, organizational climate, and leadership style. This cross-sectional study used purposive sampling to recruit 297 nurses with occupational registration in a regional teaching hospital; the valid questionnaires of 277 of them were analyzed. The study made three findings. First, those with advanced experience in the NCL system (i.e., the most advanced level with junior seniority) were more willing to participate in the NCL system. Second, the organizational climate was significantly related to nurses' willingness to participate in the NCL (r= .60, p＜ .001). In addition, leadership style and willingness to participate in the NCL were significantly positively related (r= .50, p＜ .001) and so were leadership style and organizational climate (r= .77, p＜ .001). Third, the factors significantly related to the willingness to participate in the NCL system were performance standards (β= .32, p＜ .001), transformational leadership (β= .19, p＜ .01), and rewards (β= .25, p＜ .001), which could explain 40.6% of the variation in nurses' willingness to participate in the NCL system. These findings indicate the influence of organizational climate and leadership on nurses' willingness to participate in the NCL system. Therefore, to enhance nurses' willingness to participate in the NCL system, we recommend for nursing supervisors to undergo management courses regarding organizational leadership. Furthermore, we recommend for nursing supervisors to not only actively advise the hospital manager to combine NCL and performance systems but also flexibly apply different management strategies to create a positive organizational climate to enhance the willingness of primary care nurses to participate in the NCL system.

1. 刁綺慧,胡馨方,王姮樺,何幸美,陳繪竹(2019)。提升個案報告撰寫完成率。志為護理─慈濟護理雜誌，18(1)，101-113。
   連結：
2. 張純純,李美英(2015)。實作導向的個案報告訓練成效評值。領導護理，16(4)，66-75。
   連結：
3. 許順旺,嚴雯聖,鍾孟蓉,許中駿(2016)。國際觀光旅館市場導向、組織學習與組織創新之相關研究─以組織氣候為干擾變項。運動休閒餐旅研究，11(2)，85-107。
   連結：
4. 曾旭民,郭惠敏,高有怡,林幼麗(2018)。以平衡計分卡的觀點探討團隊績效與護理領導型態之關聯。志為護理─慈濟護理雜誌，18(1)，63-76。
   連結：
5. 蔡富川,陳金淵(2011)。透析中心護理主管領導風格與經營績效之相關性探討。醫務管理期刊，12(3)，166-176。
   連結：
6. Bass, B. M.(Ed.),Avolio, B. J.(Ed.)(1994).Improving organizational effectiveness through transformational leadership.Sage Publications.
7. Jack, K.(2015).The ues of poetry writing in nurse education: An evaluation.Nurse Education Today,35(9),e7-e10.
8. Knoche, E. L.,Meucci, J. H.(2015).Competencies within a professional clinical ladder: Differences in understanding between nurse managers and staff nurses.Journal for Nurses in Professional Development,31(2),91-99.
9. Ko, W. H.,Kang, H. Y.(2019).Effect of leadership style and organizational climate on employees’ food safety and hygiene behaviors in the institutional food service of schools.Food Science & Nutritio,7(6),2131-2143.
10. Litwin, G. H.,Stringer, R. A.(1968).Motivation and organizational climate.Division of Research Graduate School of Business Administration, Harvard University.
11. Melnyk, B. M.,Gallagher-Ford, L.,Long, L. E.,Fineout-Overholt, E.(2014).The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in rael-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs.Worldviews on Evidence-Based Nursing,11(1),5-15.
12. Mohamed, L. M.(2016).Assessing the effects of transformational leadership: A study on Egyptian hotel employees.Journal of Hospitality and Tourism Management,27,49-59.
13. Moore, A.,Meucci, J.,McGrath, J.(2019).Attributes of a successful clinical ladder program for nurses: An integrative review.Worldviews on Evidence-Based Nursing,16(4),263-270.
14. Pertiwi, B.,Hariyati, T. S.(2019).The impacts of career ladder system for nurses in hospital.Enfermeria Clinica,29,106-110.
15. Riley, J. K.,Rolband, D. H.,Jame, D.,Norton, H. J.(2009).Clinical ladder: Nurses' perceptions and satisfiers.The Journal of Nursing Administration,39(4),182-188.
16. Warman, G. A.,Williams, F.,Herrero, A.,Fazeli, P.,White-Williams, C.(2016).The design and redesign of a clinical ladder program: Thinking big and overcoming challenges.Journal for Nurses in Professional Development,32(6),E1-E7.
17. 台灣護理學會 (2018，11 月 10 日 )．基層護理人員臨床專業能力進階制度規劃指引．http://www.twna.org.tw/frontend/un10_open/welcome.asp#
18. 利怡慧,林伶黛,蔡菁菁,周嫚君,林梅香(2012)。N3 護理人員參加臨床能力進階制度意願之相關影響因素。護理雜誌，59(1)，41-50。
19. 國家教育研究院 (2019)．國語詞典簡編本．http://dict.concised.moe.edu.tw/jbdic/search.htm
20. 莊玉嬪(2003)。國立雲林科技大學工業工程與管理研究所。
21. 許士軍(1977)。工作滿足、個人特徵與組織氣候─文獻探討及實證研究。國立政治大學學報，35，13-56。
22. 陳幼貴(2014)。提升腫瘤科護理師臨床專業能力進階完成率。腫瘤護理雜誌，14(1)，63-75。
23. 章美英,朱翠萍,鄭振鴻,劉潔儒(2011)。中醫護理人員能力表現與中醫護理學習經驗之相關初探。源遠護理，5(2)，30-42。
24. 曾妤如,陳國嘉(2016)。領導型態與組織承諾關係之研究。全球管理與經濟，12(2)，94-111。
25. 黃英忠,杜佩蘭,張肇松(2003)。組織氣候與組織承諾關係之研究─以高雄公辦民營及市立醫院為例。中國行政評論，12(3)，27-60。
26. 蔡維揚(2015)。國立高雄大學經營管理研究所。