【作者】 陈红；

【导师】 李继平；

【作者基本信息】 四川大学 ， 护理学， 2007， 硕士

【摘要】 研究背景长期以来，我国医院人才管理主要通过行政级别和技术职称两条主线，人才所受待遇与岗位价值缺乏明确的相关性，岗位价值评估在医院人力资源管理，特别是在与医务人员利益直接相关的薪酬分配体系中没有受到足够重视。目前多数医院采用的强调资历、经验、技能的薪酬制度对员工的激励作用差，由此影响其工作积极性和工作效率，也使医院的护理人员流动性及流失率呈逐年上升趋势。因此，在岗位价值评估的基础上建立科学合理的薪酬分配制度已成为医院人事制度改革的关键。H医院是一所集医、教、研为一体的大型综合性医院，有近2000名护理人员，如何将护理人员的薪酬与个人的工作能力以及与所在护理岗位的复杂程度、辛苦程度、所承担的责任和风险、岗位所需要的知识和技能、工作量大小和工作环境好坏有机结合，实现不同护理岗位“按岗取酬”，是医院护理与人事管理部门急待解决的问题。文献报道按岗取酬应建立在岗位价值评估的基础上，科学的岗位价值评估是真正实现公平地按岗取酬和充分调动人力资源动能的必然手段。目前，国内护理文献中尚没有关于护理岗位价值评估的研究和阐述。在国外医疗机构中，岗位评价上世纪七、八十年代盛行欧美，研究全面且深入的是英国卫生部。自1999年开始，英国卫生部对下属医疗机构的近100个岗位进行了分析和评估，2003年3月公开发行了医疗机构专用的岗位价值评估模型。因此，借鉴国外岗位评价的经验，结合H医院实际情况，在岗位价值评估的基础上建立科学、公平的薪酬管理体系，对推动H医院人事分配制度改革，顺利实施“按岗取酬”的护理人事分配方案具有积极的现实意义。研究目的1．利用定性和定量的岗位价值评估方法对H医院病房不同护理岗位进行价值评估，对两种评价方法评出的结果进行比较分析，从而得出较为科学、系统、量化的H医院病房不同护理岗位的价值。2．通过数据分析探索和构建H医院护理岗位价值框架，为有效进行护理人力资源管理提供基础参考数据。3．为我国医院科学地进行各类岗位价值评估提供方法学借鉴。研究方法本研究采用横断面问卷调查法。调查对象与方法H医院病房七种不同护理岗位的护士，其中包括护士长、护理责任组长、专业护士、辅助护士、无执照护士、总务护士、办公室护士。纳入标准：H医院七种不同护理岗位齐全的科室的护士。排除标准：工作年限不满半年的护士；退休及离职护士。抽样方法：采取分层随机整群抽样的方法，将H医院所有具备七种护士岗位的科室按照科室性质分为内科、外科、其他科室(由于工作的特殊性对护士工作的要求有所不同)三层，在各层中随机抽取部分科室，累计得到10个科室，对10个科室七种护理岗位的所有护理人员进行问卷调查。本次研究共抽取H医院10个科室的245名护士作为调查对象。调查工具本次使用的调查工具是《护理岗位价值评估调查问卷》。该问卷包括两种岗位价值评估方法：一种为定性评价方法：排序法；一种为定量评价方法：因素计分法。英国公开发表的护士工作评价标准是由英国卫生部公开发布的一项护理岗位评估标准，本次研究把该标准经专业人员翻译后，形成本次的调查工具《护理岗位价值评估调查问卷》。采取专家咨询方法，确认量表的适应性。该量表包括16个要素：人际交流与关系的技巧，知识、技能与工作经验，分析和判断能力，计划和组织技巧以及操作技能，对病员的责任、对组织机构发展的责任、对财经和物质方面的责任、人力资源管理的责任、对信息资源的责任、对科研以及发展的责任以及行动的自由性，体力劳动方面的要求，脑力劳动方面的要求，对情感的要求以及工作环境。通过5位护理学专家分析H医院护理工作的特点，对该问卷的16个要素给予了适当的权重，并赋予每个要素不同等级相应的分数。该调查问卷的内部一致性信度大于0.9、分半信度系数为0.995、重测信度系数大于0.8，专家认为问卷有较好的表面效度和内容效度。数据资料处理使用Excel2003软件建立数据库，把资料转入SPSS 13.0进行统计分析处理。评分的数据采取多个均数比较的方差分析的方法，并对样本均数进行SNK的两两比较；等级结果的数据采取非参数的秩和检验，并将转换后的秩次进行SNK的两两比较。排序法采用序号数相加，得出的数据由小到大进行排列，排出各护理岗位价值大小顺序。结果1．排序法排出各护理岗位价值由大到小的顺序为：护士长、护理责任组长、办公室护士、专业护士、总务护士、辅助护士、无执照护士。2．因素计分法测出各护理岗位价值分数及由大到小的顺序为：护士长(82.663)、护理责任组长(67.344)、专业护士(53.019)、办公室护士(45.479)、总务护士(44.124)、辅助护士(39.248)、无执照护士(23.692)，其中办公室护士和总务护士岗位价值分数差异无统计学意义(p＞0.05)，其他岗位之间的价值分数差异有统计学意义(P＜0.05)。3．自评与他评(对现任某个岗位的护理工作者与其他岗位护理工作者就此岗位价值的评价)比较：价值分数差异没有统计学意义的岗位有：护士长、护理责任组长、专业护士、辅助护士、总务护士、办公室护士(p＞0.05)：无执照护士对所在岗位的评价与护士长、办公室护士、总务护士对无执照护士岗位的评价，价值分数的差异无统计学意义(p＞0.05)；无执照护士对所在岗位的评价与护理责任组长、专业护士、辅助护士对无执照护士岗位的评价，价值分数的差异有统计学意义(P＜0.05)。4．各护理岗位在不同科室的价值比较：护士长、总务护士、办公室护士、无执照护士岗位在各个科室的价值评分两两比较结果显示，这四个岗位在各科室的价值分数差异没有统计学意义(p＞0.05)；护理责任组长、专业护士、辅助护士岗位在内、外性质科室的价值分数差异没有统计学意义(p＞0.05)，而这三个岗位在内外科性质科室的价值得分分别与在其他科室的价值得分差异有统计学意义(p＜0.05)。结论1．H医院各护理岗位的相对价值大小顺序对该院人事分配方案的制定及有效进行人力资源和护理岗位管理具有重要的参考价值。2．《护理岗位价值评估量表》的16个评价要素能反映H医院护理工作的特点，可进一步用于H医院护理岗位价值评估研究，并可作为我国医院进行各类岗位价值评估的方法学借鉴。本次研究的局限性1．由于抽样科室的限制，有些具有代表性的科室未纳入本次研究，使本次岗位价值评估的代表性受到一定影响。2．由于个人研究条件的限制，本次只进行了各研究岗位护理人员的自评与他评，没有第三方参加评价。更多还原

【Abstract】 BackgroundThe management of personnel in hospital by the rank of administrationand the title of a technical post was popular in China; the treatment ofpersonnel did not related to post value accurately, the post value evaluationwas not highlighted in the human resource management of hospital,especially there was lack of attention to salary distribution system that relatedto the benefit of medical staff directly. The reward distribution system thatemphasized longevity, experiences, and skills was poor incentive to staff,influenced their work enthusiasm and efficiency, and increased the floatingand the rate of dimission of nurses year by year. So to establish scientific andreasonable reward distribution system based on post value evaluation iscrucial to the reform of hospital personnel system.H hospital is a large comprehensive hospital that includes medicalservices, teaching, and research, has near to 2000 nursing staff, how tocombine tightly the reward of nursing staff and the personal working ability,the complicated grade of nursing post, hardship grade, responsibility and risk,the knowledge and skills required, working load, and working environment in order to achieve different nursing post different salary? It is an urgent issuethat the hospital nursing and personnel management department shouldresolve. Data review showed that the post reward should be based on the postvalue evaluation; scientific post value evaluation is inevitable tool to reallyand fairly achieve different nursing post different salary, and fully mobilizethe energy of human resource.There were no reports about nursing post value evaluation up to now inChina. In abroad medical institutes, post value evaluation were popularamong the Occident during seventies and eighties in last century, the healthministry of UK had done comprehensive and embedded research of nursingpost value evaluation. From 1999, the health ministry of UK had analysesand evaluated near one hundred posts of medical institutes, and publishedpost evaluation model of medical institutes on Mar. 2003. So to establishscientific and fair reward management system based on abroad experience ofpost evaluation and the situation of H hospital has a active realistic meaningto promote the reform of personnel assignment system and successfullyimplement nursing personnel assignment proposal according to post.Objectives1. To obtain scientific, systematic, quantitative nursing post value of differentpost of H hospital wards by utilizing qualitative and quantitative postvalue evaluation methods to conduct value evaluation of different nursingpost, and comparatively analyze to the results of two evaluation methods.2. To offer basic referential data for establishing scientific, systematic,quantitative nursing post value and conducting effectively management ofnursing human resources by data analysis.3. To offer methodology model for Chinese hospitals conduct scientificallyvalue evaluation of each nursing post. Research methodsAcross-section questionnaire surveySubjects and sampling methodsNurses from seven nursing post of H hospital wards, including chargenurse, group leader of nursing duty, specialty nurse, assistant nurse, nolicense nurse, general affairs nurse, office nurse.Choice criteria: nurses who are belong to the ward that includes all theseven posts.Excluding criteria: exclude the nurses whose work year was under half ayear, who retired and abdicated.Sampling methodsAdopt stratified random cluster sampling method, put the wards "thathave seven post of H hospital into three layers of internal medicine, surgery,special ward (the specialty of work has different needs of nurses) accordingto ward character, then randomly sample part wards in per layer, the totalnumber of sampling wards is ten, after that conduct questionnaire survey tonurses of seven nursing post of the ten wards. The total survey number were245 nurses from ten wards.Survey toolsQuestionnaire of nursing job evaluation: This questionnaire includes twomethods of post value evaluation.One was the qualitative research method: ranking method. The otherwas quantitative method: factors grading method.The nurses work evaluation criteria published in UK was the nurse postwork evaluation criteria published by the health ministry of UK, the surveytool (questionnaire of nursing post value evaluation) was developed after thecriteria was translated into Chinese by nursing professionals, then the questionnaire was modified by experts consulting in order to ensure theadaptability of the questionnaire. The questionnaire included sixteen factorstotally: communication and relationships skills, knowledge and trainings andexperiences of work, analytical skills and judgmental ability, planning andorganization skills, practice skills, responsibility to patients, responsibility toinstitution development, financial and physical responsibility, responsibilityto human resources, responsibility to information resources, responsibility toresearch and development, freedom to act, demand of physical efforts,demand of mental efforts, demand of emotional efforts, and the workconditions. The 16 factors were weighted after five nursing experts analyzedthe specialty of H hospital nursing work, and per factor were given grade ofdifferent ranks correspondingly. The internal consistency reliability wasmore than 0.9, Split-Half reliability coefficient was 0.995, and the test-retestreliability wan more than 0.9, and the face validity and content validity of thisquestionnaire were good evaluated by experts.Data processing and analysisDatabase was established by Excel 2003 software, transformed intoSPSS format, then conducted statistical analysis by SPSS13.0 software.Graded data was analyzed by multiple variance analysis, the mean of samplewas compared one by one with SNK, ranked data was analyzed bynonparametric rank sum test, the ranks were compared each other. Datasequence number was added by compositor method, the new data was rankedfrom small to big, and then we got the sequence of magnitude of nursing postvalue.Results1. The sequence from small to big of nursing post value by compositormethod were charge nurse, group leader of nursing duty, office nurse, specialty nurse, general affairs nurse, assistant nurse, no license nurse.2. The sequence from small to big of nursing post value grade by factorsgrading method were charge nurse (82.663), group leader of nursing duty(67.344 ), specialty nurse (53.019 ), office nurse (45.479), general affairsnurse (44.124), assistant nurse (39.248), no license nurse (23.692) .Thedifference of nursing post value grade between office nurse and generalaffairs nurse was no statistical meaning (p＞0.05), and the value gradebetween other posts was statistical meaning (p＜0.05).3. The comparing of self-evaluation and other-evaluation, i.e. the post wasevaluated by nurses themselves and by other nurses, showed that the postof value difference of no statistical meaning were charge nurse, groupleader of nursing duty, specialty nurse, assistant nurse, office nurse,general affairs nurse (p＞0.05); the difference of post value evaluation ofno license nurse comparing with charge nurse, office nurse, generalaffairs nurse was no statistical meaning (p＞0.05) ; the difference of postvalue evaluation grade of no license nurse comparing with group leaderof nursing duty, specialty nurse, assistant nurse was statisticalmeaning(p＜0.05).4. The compare of nursing post in different sections: the comparing of nursepost value of different wards one by one showed that the value differenceof charge nurse, general affairs nurse, office nurse, and no license nursepost value grading of different wards was no statistical meaning (p＞0.05) ;the difference of value grade among group leader of nursing duty,specialty nurse, assistant nurse post in medical and surgical sections wasno statistical meaning(p＞0.05 ), the difference between value grade of thisthree posts in medical and surgical sections and in special sections was statistical meaning (p＜0.05)Conclusions1. The sequence of relative value size of each nursing post of H hospital hasimportant referenced value to design personnel assignment proposal andconduct effectively management of human resources and nursing posts forH hospital.2. The sixteen evaluation factors of evaluation questionnaire of nursing postvalue reflect the nursing work characteristics of H hospital, it will behelpful to conduct further research of nursing post value evaluations in Hhospital and use for reference of methodology to conduct different postvalue evaluation in Chinese hospitals.Limitations in this study1. Because there are limitations of sampling of sections, some sections thatare good representative are not sampled, so the representativeness of jobevaluation is influenced at a certain extent.2. Because the there are limitations of research condition, so this study haveonly conducted the study involving the self evaluation and other evaluationof nursing staff, no other staff.更多还原