護理人員離職行為影響因素及工作負荷之探究

A Study on the Turnover Behavior Factors and Workload of Nursing Staff

背景：台灣護理人員執業率約63.0％，工作年資平均7.67年，與歐美國家相差甚遠。目的：本研究旨在了解護理人員離職行為影響因素及工作負荷之探究。方法：本研究採橫斷式研究設計，以中部某區域教學醫院做為研究對象之收集，此教學區域醫院共有1352床，護理人力約有1300人，採方便性取樣，針對2016年06月－2018年12月離職人員進行原因分析及調查，以SPSS 20.0套裝軟體統計次數分配、百分比、獨立t、單因子變異數分析、線性回歸進行相關檢定及各變項關係。結果：共收集245名。護理人員離職時，最不滿意前五名因素，分別為工作負荷（M±SD＝3.45±0.92）、健康狀態（M±SD＝3.45±0.93）、護病比（M±SD＝3.52±0.87）、照護能力（M±SD＝3.62±0.76）、交通便利性（M±SD＝3.68±0.87）。其中，以工作負荷位居首位。推論性統計發現，工作負荷與護病比（p＝.002, p＜.01）、健康狀態（p＝.001, p＜.01）、照護能力（p＝.045, p＜.05）、照護品質（p＝.042, p＜.05）、成就感（p＝.040, p＜.05）呈相關性，具統計上顯著意義。線性回歸發現護病比（p＝.000, p＜.01）、健康狀態（p＝.003, p＜.01），照護能力（p＝.000, p＜.01），對工作負荷具有顯著的影響性。結論／實務應用：工作負荷為護理人員離職時最不滿意之因素。工作負荷分生理及心理兩層面；欲降低工作負荷，除落實護病比外，更需強化照護能力。

Background: The practice rate of nursing staff in Taiwan is about 63.0% and the average working duration is 7.67 years. It is far below the figures in European and American countries. Purpose: This study aimed to explore the factors associated with nursing staff turnover and workload among them. Methods: This study used a cross-sectional research design to collect information from nursing staff in a teaching hospital in central Tawain. There were 1352 beds in this teaching hospital and about 1,300 nursing staff. Convenient sampling was used in this study. Data were collected from June 2016 to December 2018. Data were analyzed by SPSS 20.0 software. The statistical methods included frequency distribution, percentage, independent, one-way ANOVA, Pearson correlation, and multiple linear regression. Result: A total of 245 people were enrolled. Workload (M±SD=3.45±0.92), health status (M±SD=3.45±0.93), nurse-patient ratio (M±SD=3.52±0.87), care capacity (M±SD=3.62±0.76), traffic round-trip convenience (M±SD=3.68±0.87) were the top five factors of nurse leaving. Inferential statistics found that workload is the primary factor for nurses leaving. Also, nurse and patient ratio (p= .002, p< .01), self-health status (p= .001, p<.01), self-care ability (p= .045, p< .05), patient care quality (p= .042, p< .05), and sense of accomplishment (p= .040, p< .05) were correlated to workload and the correlations reached statistically significant. Multiple regression found that the ratio of nurse to patient (p= .000, p< .01), health status (p= .003, p< .01), care ability (p= .000, p< .01) were significant predictors of workload. Conclusion: Workload is the most unsatisfactory factor that lead to turnover. Workload includes both physical and psychological burden. To reduce the workload, reducing nurse to patient ratio and strengthening nurses' ability to care could be two effective strategies.