Exploring the Relationship among Demographic Factors, Job Factors, Job Perception, Other Job Opportunities and Turnover Intention of Nursing Staffs

目的：探討：壹、基層護理人員對擔任護理現職之工作認知與其離 職傾向；貳、基層護理人員背景、職務因素、護理工作認知、其他工作機會與離職傾向的關聯，藉由結構方程式(structural equation modeling)驗證其間的關聯性；參、調查填寫問卷後六個月內已確認「真正離職」護理員工的數目，以探究以上各個因素與「確認離職」其間的關聯。法：本研究以台北縣內區域醫院、地區醫院和基層醫療機構非主管階級護理人員為對象，使用不記名問卷進行收樣發出2725份問卷，回收1767份，整體回收率64.84 %。資料建檔後進行基本資料分析、相關性分析、單因子變異數分析、再以結構方程式進行驗證性因素分析及路徑結構分析，探究護理人員背景因素、職務因素、護理工作認知、其他工作機會對離職傾向的影響。另以邏輯式迴歸探究以上各個因素與「確認離職」其間的關聯。果：壹、基層護理人員之「護理工作認知」偏低；「離職傾向」偏高。貳、「護理工作認知」為「離職傾向」的顯著負向預測因子(迴歸參數值-0.328)；「其他工作機會」為「離職傾向」的顯著正向預測因子(迴歸參數值0.310)。「護理工作認知」越低或「其他工作機會」越高，則其「離職傾向」越高。護理人員背景及職務因素中，「學歷、職務類別、是否屬新進護理人員、工作單位性質」對離職傾向之影響為顯著。「高學歷(教育程度)、職務類別屬正式人員、工作單位性質為正常上班時間而不需輪夜班」者，其「離職傾向」較低；屬於新進人員其「離職傾向」較高。其他項目如護理人員年齡、性別、婚姻狀況、有無宗教信仰、所屬機構性質(公私立)、所屬機構層級(規模)、上班交通便利性並不是影響離職傾向的重要因子。參、「確認離職」模式中，離職傾向與其他工作機會為「確認離職」顯著之正向預測因子，護理工作認知是「確認離職」顯著之負向預測因子，可以有效預測與解釋確認離職，而護理人員背景及職務因素各個項目之影響則不顯著。離職傾向為「確認離職」最強的預測因子(勝算比3.1566)，其次為其他工作機會(勝算比1.4493)。 論：各個因素影響「離職傾向」以及「確認離職」是多因子、多層次的，可分為直接和間接影響。除了對「護理工作的認知」會影響「離職傾向」以及「確認離職」外，護理人員離職還會考量是否有「其他工作機會」。自覺較容易獲得其他工作機會者，「離職傾向」較高，也比較會有真正的離職行動。護理人員離職是醫療機構管理的重要課題。本研究可供護理工作和醫療管理者在研究或計畫解決此一問題時，做為參考和運用。Objectives: To explore: 1. attitudes of nursing staffs toward job perception and turnover intention; 2. the relationship among demographic factors, job factors, job perception, other job opportunities and turnover intention of nursing staffs by structural equation modeling; 3. the relationship between each factor mentioned above and identified leaving job of nursing staffs by collecting the data of really leaving job within six months from the survey of questionnaire. ethods: Nursing staffs of regional, district hospitals and clinics in Taipei County were enrolled in the survey, in which 1,767 self-administered questionnaires had been collected, with a response rate of 64.84% (2,725 questionnaires sent out). The data was analyzed by basic descriptive analysis, correlation analysis, analysis of variance and structural equation modeling respectively, with confirmatory factor analysis and path analysis to explore the relationship among above factors and turnover intention. Logistic regression was applied to check the relationship between each factor and identified leaving job. esults: 1. Nursing staffs have a lower level of job perception and a higher level of turnover intention. 2. Job perception is a significant and negative predictor of turnover intention (coefficient β: -0.328); Other job opportunities is a significant and positive predictor of turnover intention (coefficient β: 0.310). The lower the level of job perception is; the higher the level of other job opportunities is, and the higher the level of turnover intention is. Among all demographic and job factors, education status, whether the job is formal or not, whether the staffs are rookies in the nursing profession or not, and whether the staffs have a night-shift work (instead of a daytime work) or not are significant factors in the model of turnover intention. Nursing staffs with a higher education level, with a formal job, and with a daytime work grossly have a lower level of turnover intention. Nursing staffs who are rookies in the nursing profession have a higher level of turnover intention. In contrast the other demographic and job factors including age, sex gender, marriage status, beliefs of religions, working situations (public or private hospitals), the scale of hospitals (large or small), and spending time in going to work are not important predictors to turnover intention. 3. In the model of identified leaving job, both turnover intention and other job opportunities are significant and positive predictors of identified leaving job; job perception is a significant and negative predictor of identified leaving job. However the effect of items in both demographic and job factors to identified leaving job seems insignificant. Turnover intention is the strongest predictor (Odds Ratio: 3.1566) of identified leaving job; the secondary is other job opportunities. (Odds Ratio: 1.4493) onclusions: The mechanism for the complex effects of all factors to turnover intention and identified leaving job of nursing staffs is multi-factorial and also multi-level, including direct and indirect pathways. In addition to job perception, other job opportunities will be taken into consideration for nursing staffs in deciding to leave their jobs. Nursing staffs with a higher perception of easily obtaining other job opportunities have a higher level of turnover intention and are subject to real actions of leaving job. Leaving job of nursing staffs is an important issue to the management of health care organizations. This study may serve as a reference and utility for nursing staffs and medical managers who focus on researching or solving this problem.口試委員會審定書………………………………………………………………………i謝………………………………………………………………………..…………….ii文摘要………………………………………………………………………………..iii文摘要…………………………………………………………………………..……v錄…………………………………………………………………………………....viii目錄…………………………………………………..………………………………x目錄………………………………………………………………………………….xii一章 緒論 ……………………………………………………………1二章 名詞解釋及文獻探討………………………………………………………5一節 角色認知、護理工作認知的意義及相關概念………………………….5二節 離職傾向定義與離職相關理論；離職傾向與其他工作機會關聯…….12三節 結構方程式……………………………………………………………...18三章 材料與方法…………………………………………..……………………….42一節 研究架構與研究對象…………………………………………………...42二節 問卷設計………………………………………………………………...43三節 統計分析方法……………………………………………………..……47四章 研究結果……………………………………………………………………..50一節 樣本概述………………………………………………….…………….50二節 基本資料及員工職務分佈….………………………………………….50三節 所有量表表內各項目相關分析………………………………………..51四節 所有量表指標項目的一般統計………………………………………..51五節 不同背景及職務護理人員之平均離職傾向…………………………...52六節 結構方程式分析………………………………………………………..59七節 確認離職分析………………………………………………………….109五章 討論(含研究限制)…………………………………………………………..113六章 結論與建議………………………………………………………………….118考文獻……………………………………..……………………………….………126錄一 基層護理人員工作認知與離職傾向研究問卷…………………………….13