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

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.