最後一哩學程改善新進護理人員職場疲勞與工作表現之成效探討

Reducing Occupational Burnout and Enhancing Job Performance in New Nurses: The Efficacy of 'Last Mile' Programs

背景：新進護理人員進入臨床是一段壓力與挑戰的角色轉換過程，臨床技能不足與工作適應困難，導致新進人員離職率居高不下，進一步加劇健康照護部門護理專業人員的短缺。最後一哩學程強調透過產學合作，共同設計課程，以彌補學校教育與實際作業之差距，增加應屆畢業護生之職場適應能力。目的本研究目的為探討最後一哩學程改善新進護理人員職場疲勞與工作表現之成效。方法採類實驗研究設計，以三所護理技職體系學校應屆畢業生為對象，分為最後一哩學程組（n = 29）和沒有參加最後一哩學程組（n = 94）。最後一哩學程是由研究者與學校共同規劃並經專家效度檢定，學程包括課室教學84小時和臨床實習160小時。護理工作表現量表採國外Greenslade和Jimmieson發展之問卷，經翻譯、回返翻譯建立中文版，再以因素分析取得八因素，社會支持、提供資訊、協調照護、技術性照護歸類為任務工作表現概念，人際間支持、工作職務支援、自願負擔額外任務以及遵從性歸類為情境工作表現概念，八因素信度介於.70- .95。職場疲勞量表分為個人疲勞、工作疲勞、服務對象疲勞以及工作過分投入四概念，信度介於.84- .90。在新進護理人員到職第1、3、6個月進行資料收集，並以重複測量變異數分析法、獨立t檢定進行資料分析。結果123位新進護理人員，平均年齡23歲，有無參加最後一哩學程者在教育程度、工作單位等基本屬性皆無統計差異。在護理工作表現方面，參加最後一哩學程新進護理人員於到職6個月時的工作職務支援、自願負擔額外任務以及整體任務、情境表現顯著高於沒有參加最後一哩學程的新進護理人員。職場疲勞方面，參加最後一哩學程的新進護理人員於到職6個月時的服務對象疲勞亦顯著低於沒有參加者。結論／實務應用最後一哩學程能增加新進護理人員情境工作表現並減低其對服務對象之疲勞。本研究建立之學校、醫院共同合作模式，可提供醫院管理者和教育者於規劃新進護理人員留任策略之參考。

Background: New nurses undergo a stressful and challenging transition process in the nursing workplace. Lack of patient care knowledge and skills and work adaption difficulties lead to a high turnover rate that drains essential new talent away from the nursing profession and further exacerbates professional staffing shortages in the healthcare sector. The “last mile” program is a program developed jointly by a nursing school and hospital as a mechanism to bridge classroom learning to clinical practice and smooth the transition of nursing students into nursing professionals.Purpose: The purpose of this study was to understand the effect of the ”last mile” program on job performance and occupational burnout among new nurses.Methods: We conducted a quasi-experimental study in 2009 on a convenience sample of new nurses in a medical center. Participants were assigned into two groups, namely those enrolled in the last mile program (n = 29) and those not enrolled in the program (n = 94). Research team members and several collaborative universities developed the last mile program used in this study; Seven experts established content validity; The last mile program included 84 hours of lecture courses and 160 hours of clinical practice. Data was collected using the nursing job performance scale developed in 2007 by Greenslade and Jimmieson and translated / back translated into an equivalent Chinese version. Exploratory factor analysis showed all items aggraded into 8 factors, which could be divided into task performance and contextual performance concept categories. Task performance concepts included: social support, information, coordination of care, and technical care; Contextual performance concepts included: interpersonal support, job-task support, volunteering for additional duties and compliance. The Cronbach’s α for the 8 factors were .70-.95. The occupational burnout inventory included the 4 subscales of personal burnout, work-related burnout, client-related burnout, and overcommitment, with associated Cronbach's α ranging from .84-.90. Data was collected at one, three, and six months after employment. Repeated measures ANOVA and an independent t-test were used to analyze data.Results: The average age of the 123 participants surveyed was 23 years, with no differences identified between lastmile and non-last-mile groups in terms of education level, work unit, or other demographic variables. New nurses who participated in the last mile program achieved significantly higher performance scores for job-task support, volunteering for additional duties, and overall task and contextual performance than those who did not. Last-mile-program group participants also had significantly lower client-related burnout than their non-last-mile-program peers.Conclusions / Implications for Practice: The last mile program facilitates new nurses' contextual performance and reduces incidence of care burnout. The cooperative education model linking universities and hospitals can be a positive component in a new nurse retention strategy for hospital administrators and educators.