影響台灣護理師及醫師組織承諾的因素：一個勞動過程的觀點

Organizational Commitment of Nurses and Doctors in Taiwan: A Labor-Process Perspective

勞工對組織的承諾或忠誠度在組織心理學、產業心理學、產業社會學、工作與職業、或勞動社會學中是常見的研究課題。承諾反映的是對於組織價值的認同及願意積極表現。近年來台灣的醫護人員屢屢公開抗議勞動條件的惡化與職場的不友善，如：工時過長及暴力事件頻傳，而要求院方改進。本文從勞動過程的角度，分析工作條件與勞動過程中的成就感等因素對醫護人員組織承諾的影響及專業與性別間的差異。使用的資料來自於2014年對三家醫院醫護人員的問卷調查。總共回收問卷超過4,000份。結構方程模型的分析結果顯示，護理人員的組織承諾高於醫師，公立醫院醫護人員對組織的認同感高於私立醫院。惡劣的勞動條件影響工作滿意度，對醫護人員的組織忠誠度雖也有負面影響，但未達統計上顯著水準。顯示滿意度與組織承諾的形成有不同的解釋架構。護理及醫師均屬於專業人士。在勞動過程中感到工作的意義和成果、可以學習新事務；同仁彼此間、基層與主管之間的社會關係良好，對於提高組織認同有顯著影響。本文也發現，敵意的工作環境，包括曾在職場中受過暴力經驗（包括被同事霸凌），對於護理人員的組織承諾有顯著的負面影響。研究結果證實勞動過程觀點的解釋力及影響勞工組織承諾因素的複雜性。

Organizational commitment (OC) has been a topic attracting a multitude of studies in social sciences. OC represents an identification with the values and involvement in organizations. Factors affecting OC include organizational characteristics and work factors. Medical workers have complained about their long work hours, too much overtime work, and low pay. This paper adopts a labor-process perspective to examine the effects of labor conditions and subjective evaluation of the worth of work on OC. The data came from a selfadministered questionnaire survey to nurses and doctors in three hospitals (two public, and one private) in Taiwan in 2014. There are more than 4,000 valid observations in the analysis. Using structural equation modeling (SEM), the authors find that nurses on average have greater OC than doctors, and medical workers in the two public hospitals have greater OC than those in the private one. Feeling empowered in the labor process and having supportive social relations in the workplace have positive effects on OC for both nurses and doctors. Working in hostile environments such as having been assaulted by patients and colleagues lowers nurses' OC. Overall findings confirm the explanatory power of the labor process factors and indicate the complexity of obtaining labor's consent in the workplace.