【作者】 金钰梅；

【导师】 胡雁； 李健； 钱建萍；

【作者基本信息】 复旦大学 ， 护理学， 2010， 硕士

【摘要】 背景：护士短缺已成为一个世界性的问题,据报道,美国护士短缺越来越严重,预测到2020年美国护理服务的需求将超过供应几乎30%；英国也在经历护士的严重短缺,加拿大、德国,甚至新西兰等国家,都在遭受护士短缺的问题。国内由卫生部统计信息中心提供的2003-2007年我国卫生发展情况简报中指出我国每千人口注册护士已由1.00人增加到1.12人,2007年我国病房护士与床位之比平均为0.38：1,但尚未达到国家卫生部1978年护士配备标准。嘉兴地区也不例外,截至2007年底嘉兴市共有注册护士数5583人,每千人口护士数1.66人,病房护士与床位之比约为0.34：1,护理人力资源仍然不足。护士的短缺在一定程度上影响护理质量和患者满意度,制约了护理专业的进一步发展。探索造成护士离职的原因,降低护士的离职率,稳定护理队伍,是目前护理管理领域关注的重点。目的：调查浙江省嘉兴地区二级甲等及以上医院护士的健康功能、职业疲溃感、工作满意度以及离职意愿现状,并分析其健康功能、职业疲溃、工作满意度以及离职意愿的相关性,探索影响护士工作满意度和离职意愿的因素。方法：对嘉兴地区11所二级甲等及以上医院2220名注册护士进行问卷调查,回收有效问卷2010份,问卷包括护士的一般资料调查表、SF-8健康功能量表、Maslach职业疲溃感量表、Warr工作满意度量表和Michael离职意愿量表。采用SPSS15.0统计软件对资料进行描述性分析、两样本t检验、单因素方差分析、Pearson相关分析、二分类Logistic回归分析及多重线性逐步回归分析。结果：嘉兴地区护士的健康功能得分74.41±11.51,有86.4%的护士有不同程度的颈肩痛或腰痛,50.1%的护士认为由于健康原因在一定程度上影响了社交活动；79.8%的护士有情绪困扰；61.5%的护士认为由于身体或情绪上的原因而在不同程度上影响了日常工作、学习或活动；64.7%的护士有不同程度的睡眠障碍问题(入睡困难、早醒或多醒等)。护士职业疲溃情绪衰竭得分为22.08±11.47,工作冷漠感得分6.81±5.71,低成就感得分为29.64±10.30。护士情绪衰竭和工作冷漠感2个维度处于中等水平,成就感得分较低。护士的工作满意度总分为48.40±7.88,其中工作状态得分为30.31±5.94,工作中的人际关系为18.08±2.65,均呈一般水平；护士对同事关系满意的比例为78.5%；对直接领导满意为71.5%；对领导和下属关系满意的比例为53.6%；但对收入满意的比例仅为13.4%。职业疲溃、健康功能和护士从事夜班情况等因素与满意度密切相关,能解释工作满意度总体变异度的38.8%(R2=0.388),其中情绪衰竭是影响工作满意度的最重要因素,能解释总变异的28.5%,其次是健康功能和低成就感(分别是6.4%和1.9%)护士离职意愿得分为14.74±3.24,指标值为61.42%,得分最高的是离职意愿Ⅲ(获得外部工作可能性),其指标值达到69.5%,其次是离职意愿Ⅰ(辞职可能性)和离职意愿Ⅱ(寻找其它工作的动机)。有11.4%的护士经常考虑辞去目前的工作,19.4%的护士经常在寻找不同性质的工作。护士的职业疲溃、工作满意度、健康功能和个人特征包括所在科室、年龄、工作年限、学历、任职方式、月薪收入与离职意愿密切相关,能够解释离职意愿总体变异度的30.3%(R2=0.303)。其中情绪衰竭对离职意愿的影响最大,能解释总变异的15.7%,其次是工作年限和满意度(分别是7.3%和4.9%)。护士认为离职最主要的可能原因是工作风险太高,其次是报酬太低、工作条件不如意和健康原因等。结论：嘉兴地区护士健康功能不佳,护士处于中度的情绪疲溃和工作冷漠状态,从工作中感受到的成就感普遍处于低水平,工作满意度处于一般水平。职业疲溃、健康功能、从事夜班情况是影响护士工作满意度的重要因素。护士的离职意愿处于较高水平,护理队伍处于相对不稳定状态；影响护士离职意愿的因素包括护士个人特征和职业特征、职业疲溃感、工作满意度和健康功能；职业疲溃程度越严重,离职意愿越强烈；工作满意度越低,离职意愿越高；护士的健康功能也是影响离职意愿的一个重要变量；针对护士的工作满意度和离职意愿现状及其影响因素,应采取有效的对策,如加强护理人力配置；提高护士经济和社会待遇；重视编外合同护士队伍建设；建立安全保障机制,控制护理风险；逐步实现护士按职上岗制度；大力培养专科护士,提供专业实践发展机会,充分发挥护士的积极性；重视护士的身心健康,以达到提高护士工作满意度,减少离职率,稳定护士队伍,确保护理质量和护理安全的最终目标。更多还原

【Abstract】 Background:Shortage of nurse is a worldwide problem. It was reported that there is an increasingly serious shortage of registered nurses in USA, predicted the demand for nursing services will exceed the supply by nearly 30% in 2020; UK is also experiencing a serious shortage of nurses. Canada, Germany, and even New Zealand and other developed countries, are suffering the same issue. In China, National statistical report from the Ministry of Health offered by the Center for Health Development in China 2003-2007 briefing pointed out that registered nurses per thousand population rose from 1.00 people to 1.12 in China’s mainland, by 2007 the average ratio of nurses and beds was 0.38:1, however, have not yet reached the standard of the Ministry of Health in 1978.Nursing resources are insufficient in Jiaxing area too. By the end of 2007 the total number of registered nurses was 5583,1.66 nurses per thousand people, the ratio of nurses and beds was about 0.34:1. The shortage of nurses to a certain extent affects the quality of care and patient satisfaction, restricts the further development of the nursing profession. What is the reason caused nurses to leave? The current focus for nursing administrators is to improve nurse satisfaction and reduce nurse turnover. It is expected that based on this study, strageties for further intervention might be proposed so as to improve physical and mental health, alleviate the nursing burnout, enhance the job satisfactionand reduce nurse turnover.Objectives:To investigate the status of nurses’health functioning, burnout, job satisfaction and intent to leave in GradeⅡLevelⅠhospitals in Jiaxing area, and analyze the relationship among job satisfaction, burnout and intent to leave, and to analyze factors influencing job satisfaction and intent to leave.Methods:A total of 2010 nurses from 11 GradeⅡLevelⅠhospitals were investigated by questionnaire which including Medical Outcomes Study Short From(SF-8), Maslach Burnout Inventory(MBI), Warr Job Satisfaction Scale of nurses and Michael Intent to leave Questionnaire(ILQ). The Statistical Package for Social Sciences (SPSS15.0) software was used to analyse the data, including descriptive analysis, t-test, one way ANOVA, Pearson correlation analysis, Binary logistic regression analysis and multiple linear stepwise regression analysis.Results:The findings showed that nurses health functioning score was 74.41±11.51, With 86.4% nurses reporting varied degrees of body pain,50.1% had affected social activities,79.8% reported different levels of emotional distress that affected their daily work, study or activities, 64.7% of nurses have different levels of sleep disorder problems (difficulty falling asleep, early awakening or more awake, etc).The emotional exhaustion score of nurses was 22.08±11.47, depersonalization was 6.81±5.71, reduced personal accomplishment was 29.64±10.30. It showed moderate levels of Emotional Exhaustion and Depersonalization, and low levels of Personal Accomplishment.The results also showed that the total score of job satisfaction was 48.40±7.88, with working condition subscore as 30.31±5.94, Work relationships 18.08±2.65.78.5% of nurses satisfied with relationship of colleagues,71.5% satisfied with their direct supervisor,53.6% satisfied with the relationship between leadership and subordinate, however only 13.4% satisfied with nursing income. About 39% of the variance in job satisfaction could be explained by the set of independent variables including burnout, health functioning and personal characteristics of nurses(R2=0.388). Emotional exhaustion had the strongest impact on job satisfaction, which explained 28.5% of the variance, followed by health function and low sense of accomplishment (6.4% and 1.9% in respectively).The total score of intent to leave was 14.74±3.24, the value of index was 61.42%; The highest scores were intent to leaveⅢ(possibility of receiving other job), the index value reached 69.5%, followed by intent to leaveⅠ(possibility of resign) andⅡ(motivation of searching for other job opportunity). About 11.4% of the nurses often considered resigned from current job,19.4% of the nurses were seeking other job opportuneities. About 30% of the variance in intent to leave could be explained by the set of independent variables including burnout, job satisfaction health functioning and personal characteristics of nurses(R2=0.303). Emotional exhaustion had the strongest impact on intent to leave, which explained 15.7% of the variance, followed by work experience and job satisfaction (7.3% and 4.9% respectively). The main reason of considering leaving nursing job was the high working risk, followed by low pay, unsatisfied working conditions and health reasons and so on.Conclusions:Health functioning among nursing staff in Jiaxing area was low, burnout and depersonalization was in the moderate, Nurses perception of achievement from work was generally at a low level, Job satisfaction was at a medium level. The important influencing factors were burnout, health functioning and shift work. The intent to leave rate was on a relatively high level, thus nursing team was in an unstable state; Factors affecting intent to leave rate including personal and professional characteristics, burnout, job satisfaction and health functioning. The higher job burnout, the higher turnover rate. The lower job satisfaction, the higher turnover rate; Health functioning of nurses was also an important variable affecting intent to leave.The possible top four reasons for nurses leaving were high working risks, low rewards, unsatisfactory working conditions and health reasons. For the nursing staff job satisfaction, intent to leave rate status and influencing factors, effective intervenetions should be taken, such as strengthening the nursing manpower allocation; improving the economic and social treatment of nurses; emphasizing supernumerary nurse team-building; establishing security mechanisms to control nursing risks; training specialist nurses, providing professional development opportunities for practice, bringing into full play the enthusiasm of the work of nurses; emphasizing physical and mental health of nurses to improve nursing job satisfaction, so as to reduce turnover rate, stable nursing team, ensure nursing quality and safety of care.更多还原