應屆畢業新進護理人員離職相關因素之探討

1. 應屆畢業新進護理人員離職相關因素之探討 • 中文摘要 • 應屆畢業新進護理人員半年內離職率高達58.7%，各醫院無不卯足全力希望離職率能降低，否則在一直訓練新人但新人又不斷離職的惡性循環之下，護理品質堪慮，但真正的離職原因如果不知道，怎麼有方法降低呢?因此本研究目的為瞭解應屆畢業新進護理人員離職的相關因素，比較應屆畢業新進護理人員個人屬性與離職因素的差異，進而提出減少應屆畢業新進護理人員離職情況的建議。 • 本研究採橫斷式研究設計(Cross-Sectional Research Design) ，以量性研究之問卷調查法進行，採自行設計之「應屆畢業新進護理人員離職因素調查表」，研究工具效度的檢定上採專家內容效度測定，共敦請七位相關領域之學者及臨床專家做問卷的效度檢定。本問卷原來共有48題，經專家效度檢定後修訂為50題。信度部分採再測信度，Cronbach's α值為.97。研究對象為全國已加入22個縣市護理師護士公會之應屆畢業，且在地區醫院以上服務的第一個全職工作機構未滿一年辦理離職執業登記變更者。本研究自96年10月8日起至97年12月23日止，獲得全省22個護理師護士公會同意協助收案，此期間共收集全省18個縣市護理師護士公會153份問卷，其中3份為無效卷，有效回收率為98.04%。 • 研究結果顯示，在個人基本屬性部分，年齡25歲以下佔93.3%，教育程度中大學以上學歷佔63.9%，年資在3個月以內佔60.7%，聘僱情形以約用及約聘僱佔59.3%，是否簽約中有66.7%是未簽約，薪資25000元以下佔25.3%。七類離職因素之總平均值2.79(SD=0.79)，其中「護理工作特性因素」的平均值3.36(SD=0.88)為最容易影響離職之因素。本問卷採Likert量尺加以計分，3分代表有點同意，在問卷的50項中，平均值3分以上者(含3分)共有16項，其中「護理工作特性因素」佔9項。在各類離職因素分析中，「個人與家庭因素」有2項之平均值在3分以上，「薪資福利因素」有2項之平均值在3分以上，「護理工作特性因素」有9項之平均值在3分以上，「發展與進修因素」只有1項之平均值在3分以上，「組織因素」只有1項之平均值在3分以上。比較不同屬性應屆畢業新進護理人員與離職因素的差異結果發現，任職醫院層級不同在「護理工作特性因素」F值=4.13(P<0.05)呈現統計學上顯著差異，經Scheffe's事後比較則發現任職醫院層級為醫學中心(新制優等)顯著高於任職醫院層級為區域醫院(新制合格)，因工作單位不同對因「護理工作特性因素」、「發展與進修因素」、「組織因素」三個因素(P<0.05)而離職有明顯影響，因薪資不同對因「發展與進修因素」F值=3.02(P<0.05)而離職有明顯影響。 • 護理人力之不足、工作壓力、超時工作、薪資等等的不理想，再加上應屆畢業新進護理人員適應性與自我準備度不足的情況下，導致了應屆畢業新進護理人員有六成在工作三個月內即選擇離職，唯有醫療機構、護理教育，政府政策三方面共同努力改善此情形，才不致造成照護品質的降低，提供更優質的服務給民眾。

2. Factors Related to Newly-Under Graduated Nurses Turnover Rates • 英文摘要 • Turnover for incoming recently graduated nursing personnel within the first six months can be as high as 58.7%. Each hospital naturally aims to lower turnover rate, otherwise it would constantly train new employee and this new employee would most likely leave whenever the time comes. Therefore, under vicious cycle of new employee turnover, nursing quality would definitely suffer. Still, the real cause of turnover must be located to stem the tide. Thus, how to lessen the turnover would be paramount prior real solution can be found. Consequently this research is to understand the relevant turnover factors for newly employed nursing personnel who just graduated. Analysis would be focused on personal attribute for incoming graduate of new nursing personnel, and the relevancy with turnover factors. Then comparison would be made between personal attribute and turnover factor, so that suggestions would be proposed in regard to how to effectively lessen the turnover for recently graduated nursing personnel. This research adopts Cross-Section Research Design and conducts query of quantitative research. And self-designed 「Query for turnover factors of incoming recently graduated nursing employee」 is also adopted. The significant portion for research tool is further tested for retest reliability. The Cronbach's α is found to be .97. Validity test adopts expert content validity test. Research study were those who joined National union of nurses associations, R.O.C scattered over 22 counties and cities nationwide, in addition to those served at local hospitals as their first full time jobs and quit within a year. And these nurses were practicing under registered license and had a change of registration afterward. This research started on Oct. 8, 2007 and up to Dec. 23, 2008. Under the concurred assistance of 22 unions of nurses associations in collecting questionnaires, and 153 were collected from unions located at 18 counties and cities, 3 of the 153 were rated ineffective with an effective ratio of 98.04%. The findings of this study indicated that, in the individual basic attribute category, those under the age of 25 were 93.3%. 63.9% were possessing education backgrounds of and above university level. And seniority of less than 3 months was accounted at 60.7%. As for employment, those worked under contract and project employment contract were 59.3%. Within these, 66.7% were under the category of no contract protection, and 25.3% of them were paid with monthly salaries of less than 25,000 NTD. Within the seven job severance factors, the total average value was 2.79 (SD=0.79). Within the average value of 「nursing profession characteristics」 3.35(SD=0.88), which was attributed to the most significant factor that would affect the job severance. This questionnaire adopts Likert scale to measure the scores. Score of 3 represents somewhat concurred. Within 50 categories of the questionnaire, there were 16 categories with average value of 3 and above (including 3). And within these, “nursing profession characteristics” occupied 9 categories out of the 16. Within each category of analyzing the job severance, 2 of the “individual and family” item scored with average value above 3. And 2 of the “salary and benefit” average value scored above 3. 9 of the “nursing profession characteristics” scored above 3. Only 1 of the “development and pursing the advanced degrees” scored above 3. And only 1 of the “organizational considerations” scored above 3. After comparing different attributes for the soon-to-be graduated incoming nursing personnel with those of job severance factors, the variance for these indicated that, the level variance for employment hospitals exhibited statistical significance in ”nursing profession characteristics” with F value = 4.134(p<0.05). Through Scheffe’s method, it discovered that the employment hospital level rated as medical center (new system rating as excellent) exhibited significantly higher rating than those of regional hospital level(new system rating as qualified). Since the employment organizational differences did exist, therefore three factors like ”nursing profession characteristics”, ”development and pursing of advanced degrees” and ”organizational considerations (with P<0.05) were significantly impacting the job severance outcome, in addition that the salary difference was also significantly impacting the F value=3.02(P<0.05) of the job severance factor. Since the undesired manpower inadequacy, job stress and constant overtime work in addition to the adjustment and inadequate self preparation for incoming recently graduated employee were found to be the causes that result with over sixty percent turnover rate within the three months of employment time frame, this research suggests that the solution for this problem must come from combined efforts from industry, bureaucracy and academic circles. Then, future nursing quality would not be lessened and general populace can expect to be provided with superior quality of nursing service.