工作環境對護理人員職業倦怠與留任意願的中介效果

Work Environment-Mediated Job Burnout and Intention-to-Stay in Registered Nurses

背景：護理人員投入工作與留任意願，是攸關醫療與照護品質的關鍵，眾所周知，護理人員的工作環境會影響護理品質和病人照護的成效，但護理人員的工作環境、職業倦怠與留任意願的關係，則少併行探討，尤其是發展中地區。
目的：探討台灣東部地區護理人員對其工作環境的感受，並進一步分析工作環境在職業倦怠和留任意願的中介效應。
方法：採描述、相關性研究設計，自2020年9月至12月，使用一份問卷，內容包括：人口學資料，31題護理工作環境量表（Practice Environment Scale of the Nursing Work Index, PES-NWI），22題職業倦怠量表（Maslach Burnout Inventory, MBI-HSS）及6題留任意願量表（Intention-to-stay scale, ITS）等四部分，收集東部某一區域教學醫院護理人員資料，並分析各變項的關係。本研究變項採用PROCESS模型4及拔靴法（bootstrapping）進行中介效果檢定。
結果：376名受訪者之平均年齡為34.3歲（SD = 8.1）；職業倦怠次量表中以情緒耗竭分數≥27分，屬於高度職業倦怠者所佔比率最高（30.3%）；約有1/3（30.6%）不確定是否繼續留任。受訪者MBI-HSS與ITS呈顯著負相關（β= -.088, p < .001），而PES-NWI對MBI-HSS和ITS之間具有顯著的中介效應（β= -.015; p < .01）。
結論／實務應用：本研究對象雖有較高的職業倦怠得分，但工作環境的評分高低會影響留任意願的程度。因此創造正向的工作環境應能降低護理人員的職業倦怠及提高留任意願。

Background: Nurse engagement and retention are critical issues affecting the quality of healthcare. Although the work environment is known to affect nursing performance and patient outcomes, little is known regarding the impact of this environment on nurse burnout and future work intention, especially in non-Western settings.
Purpose: This study explored the extent to which Taiwanese nurses’perceptions of their practice environment mediates burnout levels and intention-to-stay.
Methods: This descriptive, correlational study, conducted between September and December 2020, recruited nurses employed at a regional teaching hospital located in a relatively rural region in Taiwan. The participants completed standardized questionnaires, including a demographic information form, the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI), the 22-item Maslach Burnout Inventory (MBI-HSS), and the 6-item Intention-to-stay (ITS) scale. The mediating effect among the variables related to intention-to-stay was examined using Model 4 of the PROCESS macro and tested using the bootstrapping method (repeated 5,000 times) with a p value < .05.
Results: The mean age of the 376 participants was 34.3 years (SD = 8.1). Nearly one-third (30.3%) scored > 27 on the emotional exhaustion subscale of the MBI-HSS, indicating they were“highly burned-out”. Also, nearly one-third (30.6%) were uncertain about their intention to stay with their current employer. Burnout was associated with intention-to-stay (β= -.088, p < .001), and holding a positive perception toward their practice environment was shown to mediate the relationship between burnout and intention-to-stay (β= -.015; p < .001).
Conclusions/Implications for Practice: Targeted interventions and technical support that promote a collaborative climate and psychological empowerment in clinical practice may alleviate burnout and intention-to-leave in nurses and improve workplace quality.