台灣健保總額預算期間臨床護理人員的工作感受及工作壓力

Work Perception and Job Stress among Clinical Nurses while Implantation of Global Budget Payment System in Taiwan

10.30027/CJOM.201201.0003

張薰榕(Hsun-Jong Chang)；史麗珠(Lai-Chu See)；邱孟君(Meng-Jiun Chou)；沈昱名(Yu-Ming Shen)；林雪蓉(Sheue-Rong Lin)

臨床護理人員 ； 工作感受 ； 工作壓力 ； 健保總額預算 ； Clinical Nurses ； work perception ； job stress ； global budget payment

中華職業醫學雜誌

19卷1期（2012 / 01 / 01）

15 - 27

繁體中文

全民健保實施總額預算後，醫院管理者為縮減預算、降低人事成本，臨床護理人員通常是首當其衝被刪減的人力。面對人力縮減，工作量提升，臨床護理人員工作感受及工作壓力是非常值得探討的課題。本研究採問卷調查，在桃園地區採分層依比例隨機抽樣選取臨床護理人員。研究工具為具信效度的健保總額預算影響工作感受量表，及醫療工作的壓力源感受量表。探討臨床護理人員在實施健保總額預算的工作感受、工作壓力，及兩者之關係。共收集374有效問卷（48.5%）。臨床護理人員對健保實施總額預算的負面工作感受總分為30.42 ± 3.78，滿分為45；由高至低為：工作量、文書處理量、醫療品質、工作時間、薪水、與病人關係、工作流程、醫藥物品的運用、人力調整。而醫療工作壓力源感受總分為36.99 ± 5.81，滿分為48；由高至低分別：面對醫療糾紛、應付醫院評鑑工作、升等或學術研究、病患病情穩定度、個人考核的制度、薪水的給付制度、維持醫療院所的營運、與病人關係的維持。醫療工作壓力源感受的影響因子解釋能力最強為教育程度，其次為健保總額預算影響工作感受、工作職等、薪水滿意，總解釋能力為11.2%。研究結果能夠提供相關單位在人力資源管理時的參考，以提供護理人員一個合理的工作環境。

As nurses comprise the major manpower in hospitals, clinical nurses is often the main personnel to reduce in order to control the rising costs of running a hospital. Since the National Health Insurance founded, the payment system have been changed several times, especially after the implementation of the total budget, work perception and stress experienced among clinical nurses is an important issue.Two questionnaires with acceptable reliability and validity, questionnaires of work perception about global budget for medical employees (WPGB) and questionnaire on medical worker's stress (QMWS) was used. A cross-sectional study with a stratified and proportional random sampling in Taoyuan was used to explore clinical nurses' WPGB, QMWS, and relationship between them.A total of 374 questionnaires (48.5%) was obtained. The total score of WPGB was 30.42 ± 3.78 out of 45. The ranking of WPGB from high to low were: workload, paper work, treatment quality, working hours, salary, relationship with patients, working procedure, medical resources, and manpower. The total score of QMWS was 34.99 ± 5.81 out of 48. The ranking of QMWS from high to low were: managing medical disputes or lawsuits, preparing the hospital for accreditation, seeking a job promotion or doing academic research, maintaining patients' disease conditions, having a good job performance, paying employees' salaries, running the hospital, to maintain the operation of hospitals, and maintaining a good relationship with patients. Factors associated with QMWS were education, followed by WPGB, job ranking, salary satisfaction and salary, explaining 11.2% variation of QMWS.We expect our results can help hospital administrators to revise the good working environment for clinical nurses.

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