新進護理人員角色轉換與工作適應歷程之質性研究

Role Transition and Working Adaption in New Nursing Graduates: A Qualitative Study

背景：新進護理人員角色轉換是充滿壓力與挑戰的過程，大約35-61%的護理人員在一年內離職，過去橫斷性量性研究無法深入描述新進護理人員角色轉換與適應歷程的動態變化。
目的：本研究目的將以質性研究了解新進護理人員到職前3個月角色轉換與工作適應歷程。
方法：以類別—內容分析法進行資料分析，研究對象為北部某教學醫院50位護理人員，透過15次的團體訪談收集資料。
結果：新進護理人員到職前3個月工作適應歷程包括三個階段：(㈠)摸索新角色：所學不足以應付現實、角色轉換的困難、無法勝任的焦慮、交班的困境、與臨床輔導緊密依附、適應工作的態度與方法、需要家人、老師、同學與室友的支持；(㈡)學習扮演新角色：學習獨立照護病人、尋找學習典範、學習適應夜班、尋求團體認同、需要同事與護理長的支持；(㈢)接受新角色：時間及工作狀況掌控能力改善、感受到單位同仁的認同、重拾工作熱忱、開始思考工作以外事物、體會且肯定同事與護理長的支持。
結論：實務應用 到職前3個月工作期間，新進護理人員面臨艱難的角色轉換過程，學姊工作指導與多元化支持有助於工作適應。研究結果可讓教育者與管理者了解新進護理人員工作適應過程，以作為未來護理教育與留任政策的實務參考。

Background: The role transition process is full of stresses and challenges for nurses. Between 35-61% nurses leave their job within the first year. Past cross-sectional quantitative studies have not provided deep descriptions of either the dynamic role transition or work adaption processes of new nurses. Purpose: The purpose of this study was to understand the role transition experience of new nurses as they transitioned into clinical practice during their first three months on the job. Methods: A qualitative approach was used. Data were collected through a semi-structured interview from 50 new nurses. Data were analyzed using category-content analysis. Results: Three stages were identified in the new nurse work adaption process over the first three-month period. These included (1) Understanding: New nurse knowledge and skills are insufficient to handle routine work, adapting to the role transition is difficult, feelings of anxiety emerge related to fears of incompetence, communication difficulties must be faced in the handover process, new nurses adopt feelings of attachment to their preceptors, they must work to adopt appropriate attitudes and approaches to nursing practice, and support is sought from family, teachers and friends; (2) Acclimation: Learning to care for patients independently, seeking role models, learning to adapt to night shifts, trying to identify with co-workers, and seeking support from colleagues, preceptors and head nurses; (3) Acceptance: Managing nursing work better in terms of time and organization, feeling gradual acceptance from co-workers, restoring personal enthusiasm for work, starting to consider other, non-work related matters, experiencing and appreciating the support of co-workers and head nurses. Conclusions / Implication: New nurses face a critical role transition process through their first three months on the job. Guidance and leadership from experienced nurses and multiple support systems can assist new nurses to acclimate to their role. Research results provide information for educators and administrators to better understand the adaption process of new nurses, and offer a reference for developing future strategies to improve nurse competency in handling their work.