【作者】 黄霞；

【导师】 李继平；

【作者基本信息】 四川大学 ， 护理管理， 2007， 硕士

【摘要】 研究背景随着我国医疗事业单位人事制度改革的持续推进，我国合同护士的比例逐年上升。截至2005年，四川省73．8％的县级以上卫生机构使用了合同护士，占护士总数的27．0％。但是，合同护士的高流失率一直是护理管理者面临的重要问题。护士工作满意度作为预测护士流失率的有效指标，一直受到各国护理研究者的关注。国内不少研究表明：我国护士工作满意度普遍较低，其中，合同护士的工作满意度更是低于正式护士。低水平的工作满意度不仅导致了护士的高流失率，还会影响护理质量和患者满意度。在影响满意度的众多因素中，工作价值观是工作满意度的主要影响因素。工作价值观作为人类基本价值观的重要组成部分，实际上是从一个侧面反应了护士的工作需求。通过分析合同护士的工作价值观，从需求的角度进行差异化激励，可以有助于护理管理者提高激励的效价和水平。探讨工作价值观对合同护士工作满意度的影响，将为建立合同护士工作满意度构架，提高合同护士满意度水平，稳定合同护士队伍提供有力的实证支持。研究目的1．了解成都市三级综合医院合同护士工作价值观与工作满意度的现状。2．探讨合同护士工作价值观对工作满意度的影响，找出促进工作满意度的工作价值倾向，为护理人力资源的管理决策提供参考依据。研究方法和对象采用横断面研究方法，使用工作价值观与工作满意度问卷对成都市七所三级综合医院临床合同护士进行全面调查。纳入标准：四川省成都市七所三级综合性医院的在职、注册合同护士。排除标准：①从事非临床工作护士；②临床进修生、实习生；③因休假、外出进修／学习等原因无法完成问卷填写的护士。测量工具工作满意度问卷：工作满意度问卷采用Weiss等编制的明尼苏达工作满意度问卷(MSQ)短题本，问卷共20个条目，包括内在满意度、外在满意度和一般满意度三个维度。该问卷Cronbachα系数为：0．820～0．849，重测信度为：0．733～0．759。工作价值观问卷：张爱卿编制，共有13种类型的工作价值观，每种类型有4题个条目，问卷共52个条目。经测评，该问卷的CVI=0．846，IA=0．865，重测信度为0．714，Cronbachα系数为0．622～0．860。以上两问卷均采用Likert 5级评分法。统计方法所有数据输入spss13．0和pems3．0统计软件分析处理。采用频率和构成比描述合同护士的一般资料；采用中位数和四分位数间距描述工作价值观和工作满意度资料。采用Friedman检验和q检验比较工作价值观和工作满意度各维度的总体差异性；采用多元方差分析比较各组间工作价值观总体的差异性；采用Kruskal-Wallis H检验，Mann-Whitney U检验和Nemenyi检验比较工作价值观和工作满意度各维度的组间差异性，P＜0．05为有统计学意义。采用逐步线形回归了解工作满意度的主要影响因素。结果1．合同护士的一般情况：合同护士25岁以下年龄段占被调查总人数的78．1％，工作年限小于3年的占被调查总人数的50．9％，文化程度以大专为主，占被调查总人数的70．7％。2．合同护士的工作价值观情况：合同护士13类价值观排在前三位的依次为：人际关系、成就动机和经济报酬(中位数分别为：13，12，12)，排在末三位的依次为：审美主义、追求新意、社会交往(中位数分别为：8，9，9)。3．合同护士的工作满意度情况：合同护士满意度得分排序依次为内在满意度、一般满意度、外在满意度(中位数分别为：2．667，2．600，2．500)，满意度得分最高的条目依次为：道德价值、社会地位、同事(中位数分别为：3，3，3)，满意度得分最低的条目依次为：报酬、提升、活动(中位数分别为：1，2，2)。4．组间比较结果：不同年龄、婚姻状况、工作年限和职称的合同护士工作价值观总体有差异(P=0．012，0．006，0．000，0．049)；不同年龄合同护士对经济报酬维度重视程度有差异(P=0．004)，不同婚姻状况合同护士对社会交往维度重视程度有差异(P=0．005)，不同工作年限合同护士对经济报酬、社会交往和安全稳定三个维度重视程度有差异(P=0．000，0．000，0．009)，不同职称合同护士对智力刺激维度重视有差异(P=0．030)；不同年龄、婚姻状况、文化程度、工作年限和职称的合同护士工作满意度得分无差异。5．工作满意度的影响因素：外在满意度的影响因素包括经济报酬、人际关系、审美主义、智力刺激、轻松舒适、社会地位(标准化β分别为-0．272，0．172，0．165，0．148，-0．130，0．088)；内在满意度的影响因素包括经济报酬、人际关系、智力刺激、利他主义、审美主义(标准化β分别为-0．323，0．272，0．235，0．111，0．084)；一般满意度的影响因素包括经济报酬、人际关系、智力刺激、审美主义、轻松舒适、社会地位、利他主义(标准化β分别为-0．319，0．239，0．203，0．124，-0．095，0．077，0．073)。结论1．合同护士人力资源队伍年龄结构趋于年轻化，职称和职位层次也偏低。2．人际关系、个人成就和经济报酬在合同护士价值体系中占重要地位，提示护理管理者应加强关注。3．合同护士工作价值观对工作满意度有影响。研究局限1．本研究为横断面调查研究，缺乏历史的纵向对照，对于各个因素之间的因果关系尚不能做出辨别。2．限于个人条件，本研究仅限于成都市三级综合性医院，研究结果能否推广有待进一步论证。更多还原

【Abstract】 BackgroundWith the personnel reform in the medical institutions, the rate of contract nurse has increased every year and the high turnover becomes an important issue for nursing managers. Job satisfaction is an effective indicator forecast for nurse turnover and patient satisfaction. Therefore, to survey and explore the factors affecting nursing job satisfaction can provide strong empirical support for stabling contract nurse and increasing patient satisfaction. Research findings indicated that the employee’s job satisfaction is related to their work value. As an important component of human values, work value reflexes the contract nurses’ demands on work. Analyzing the diversity of contract nurses’ work value can help nursing managers motivate them objectively, which is helpful for improving the quality and efficiency of clinical care.ObjectiveThe purpose of this paper was to investigate job satisfaction and work value of contract nurses in Sichuan province and to study the relationship between job satisfaction and work value, which provided the basis for nursing human resources management decisions.Participants By using the methods of descriptive research, questionnaires were conducted to 1221 contract nurses in 8 3-Class general hospitals. The practice nurses and advanced students are excluded.InstrumentationJob satisfaction: The short-form of Minnesota Satisfaction Questionnaire (MSQ), developed by Weiss et al. It contains 20 items, including three dimensions: intrinsic satisfaction, extrinsic satisfaction and general satisfaction. Cronbachαcoefficient: 0.820～0.849, test-retest reliability: 0.733～0.759.Work value: Work Value Questionnaire, developed by zhang Aiqing. It contains 52 items and 13 dimensions. The validity and reliability was measured as: CVI=0.846, IA=0.865, Cronbachαcoefficient: 0.622～0.860, test-retest reliability: 0.714.Statistical MethodsData were calculated by spss 13.0 and pems 3.0 for windows statistical package. The frequency and composition were used to describe the general data of contract nurses. The median arid quartile were used to describe job satisfaction and work value. The difference among the dimensions of work value and job satisfaction was analyzed by Friedman test and q test. The diversity of work value among different groups was compared by multi-variance analysis. The diversity of dimensions among different groups was compared by Kruskal-Wallis H, Mann-Whitney U test and Nemenyi test. The Level of significance was set at 0.05. Stepwise regression analysis was used to explore the influence factors on job satisfaction.Results1. 78.1% of the contract nurses were younger than 25 years old. 70.7% of them had less than 3 years of work experiences. The percentage with them had less than 3 years of work experiences. The percentage with junior college degree was 70.7%.2. The work value of contract nurses: the top three work value dimensions were relationship, achievement and economic rewards (median: 13, 12, 12), and the last three were aesthetics, innovation and social interaction (median: 8, 9, 9).3. The job satisfaction of contract nurses: the score of intrinsic satisfaction was 2.667, general satisfaction was 2.500 and extrinsic satisfaction was 2.600. The top three items were moral values, social status and co-workers (median: 3, 3, 3). The last three were compensation, advancement and activity (median: 1, 2, 2).4. The work value of contract nurses differed in age, marriage status, work time and professional title(P=0.012, 0.006, 0.000, 0.049). Scores of the economic rewards dimension had significant difference among different age groups (P=0.004). Scores of the social communications dimension had significant difference between different marriage status groups (P=0.005). Contract nurses with different work experiences gave different scores to economic rewards, social communications and security (P=0.000, 0.000, 0.009). Scores of the intellectual stimulation dimension had significant difference between different professional title groups (P=0.030).No significant differences were observed among different age, marriage status, education, work time and professional title groups in job satisfaction survey.5. Stepwise regression analysis applied to determine the main effect factors of job satisfaction indicated that economic rewards, relationship, intellectual stimulation, aesthetics, comfortable, social status, altruism (13=-0.319, 0.239, 0.203, 0.124, -0.095, 0.077, 0.073) had statistically significant impact on job satisfaction. 1. The age structure of contract nurses was young and their professional title and posts were at low level.2. Contract nurses attached great importance to relationships, individual achievement and economic rewards.3. Work value of contract nurses had modulatory effect on their job satisfaction.Study Limitations1. Since this study was a cross-sectional survey and lack of historical comparison, further study should be done to identify the causality of these factors.2. Larger population should be chosen for further study.更多还原