優質護理職場醫院策略方案分析

Strategies of Quality Nursing Work Environment

背景：台灣有許多醫院因護理人力不足關病房，但也有些醫院不缺護理人力，它們如何做到，是引發本研究的動機。目的：透過優質護理職場選拔得獎醫院書面資料，探討優質護理職場醫院的策略方案。方法：採多元研究法透過三階段進行，第一階段確認優質護理職場醫院評審項目；第二階段為辦理優質護理職場醫院選拔；第三階段就得獎醫院書面資料進行歸納性內容分析。結果：針對18 家獲獎醫院書面資料分析，找出五大構面策略方案，分別為（一）「領導與管理」構面：「護理主管採用參與式管理」、「傾聽基層人員意見」、「重視申訴管道」、「院方重視護理部」。（二）「人事政策及薪資福利」構面：實施「工作績效獎金」、「建立護理臨床教師制度」。（三）「結構性賦權」構面：「護理部主管參與院內重要會議」。（四）「專業照護」構面：「明訂各職級護理人員之工作職責」、「專人協助新進護理師適應工作與生活」。（五）「創新與改善」構面為「電子化護理行動車提供各項相關資訊連結」。結論/實務應用：本研究結果發現得獎醫院都有不同的策略方案，建議醫院和政府在發展優質護理職場環境時，應積極參考優質護理職場醫院的策略方案，將有助護理人力招募與留任，讓病人獲得更優質、安全的照護品質。

Background: This study is motivated by the fact that in Taiwan some hospitals closed down wards due to shortage of nursing manpower, but some other hospitals do not have this issue and how they can do it . Purpose: This study aims to review the documents from the hospital selection campaign of the quality nursing work environment to research the core strategic plan of the quality nursing work environment. Methods: The study adopts qualitative research through three phases. The first phase is to confirm assessment items of the quality nursing work environment that go through the conference of common consensus led by nursing managers. The second phase is to process the hospital selection of the quality nursing work environment. The third phase is to use inductive content analysis of competition documents from prizewinner hospitals. Finally, the study utilizes the content of structural data to induct and analyze the core contents of assessment items. Results: The strategic plan of each stage adopted mostly by 18 prizewinner hospitals is as follows. The first one is that nursing managers adopt participative management in the stage of leading and management. The second one is to use the prize of working performance and establish nursing clinical teacher system in the stage of personnel policy and salary benefit. The third one is that managers of nursing department join the majority of meetings in the stage of structural authorization. The fourth one is to identify the accountability in each level of nursing personnel clearly in the stage of professional caring. The fifth one is to connect and provide information by the electronic nursing cart in the stage of innovation and improvement. Conclusion and application: This study researches the core strategic plan of the quality nursing work environment by inductive content analysis. It is suggested that the government and hospitals while are exploring the quality nursing work environment should refer the core strategy of five domains actively. This will be useful on nursing personnel recruitment and retainment, and provide the best quality and safety caring for patients.