上司－－部屬關係品質及團隊效能對護理人員組織及專業情感承諾之影響

The Impacts of Leader-member Exchange and Group Efficacy on Nursing Staff Organizational and Professional Affective Commitment

背景：護理人才留任一直是護理行政、醫療管理關注的議題；組織情感承諾與專業情感承諾不但與護理人員離職動向有關，兩者間且具交互影響作用。目的：本研究探討護理人員與護理長關係品質，及其所屬團隊之團隊效能，對護理人員組織及專業情感承諾影響。方法：採問卷調查方式，655名任職於中部某醫學中心臨床護理人員參與此研究。資料蒐集採兩階段；第一階段問卷資料蒐集，包括個人資料及核心自我評量、自我效能兩項控制變項，以及個人層次及團隊層次預測因子，分別為上司－－部屬關係品質及團隊效能。第二階段檢測變項包括組織及專業情感承諾。兩階段皆完成問卷填寫者有347名，分別屬於25個單位。結果：以階層模式(hierarchical linear modeling , HLM)檢測結果顯示，上司－－部屬關係品質對於護理人員組織及專業情感承諾皆有正向影響；團隊效能僅對專業情感承諾有顯著預測力。團隊效能對於上司－－部屬關係品質與組織情感承諾間以及上司－－部屬關係品質與專業情感承諾間皆有顯著的調節作用。結論：團隊效能僅對專業情感承諾有直接影響，但透過團隊效能的營造，團隊效能對上司－－部屬關係品質與組織情感承諾，及上司－－部屬關係品質與專業情感承諾間有增強效用；提升護理人員情感承諾，可藉由團隊經營形塑之；護理人員情感承諾的探討，個人及團隊層次因素宜應同時考量。

The retention of a nursing workforce is an issue of concern for nursing and healthcare administrations. Studies indicate that high turnover in the nursing profession is related to both organizational and professional affective commitment. Additionally, there is an effect from the interaction between organizational and professional affective commitment. This study, using a crosslevel approach, investigated the impacts of the supervisor-subordinate relationship and group efficacy on both organizational and professional affective commitments among staff nurses. The current study utilized the survey method. The study participants were 655 nurses working at a medical center located in central Taiwan. Data were collected at two time points, T1 and T2. Besides demographic information and two control variables, including core-self evaluation and self-efficacy, lead-member exchange (LMX) and group efficacy, the predicators, were measured at T1. Both of the dependent variables, organizational and professional affective commitment were assessed at T2. There were 347 valid responses composed of 25 units. Based on the results of hierarchical linear modeling, the quality of relationship had a positive effect on both organizational and professional affective commitment. Group efficacy only directly affected professional affective commitment. On cross-level moderation, the results indicated that group efficacy moderated between the quality of relationship and organizational affective commitment as well as between the quality of relationship and professional affective commitment. Although group efficacy only exerted direct impact on professional affective commitment, it moderated the relationship between LMX and organizational affective commitment as well as the relationship between LMX and professional affective commitment. As a result, cultivating group efficacy can enhance the affective commitment of the nursing staff. With these findings, we conclude that both individual level and group level factors should be considered when examining the issues of affective commitment among staff nurses.