【作者】 张甜甜；

【导师】 李国宏；

【作者基本信息】 东南大学 ， 护理学， 2019， 硕士

【摘要】 研究目的:基于前期研究构建的护理人员综合激励模型及护理人员留职对策基本框架,制定护理人员综合留职对策,并评价其应用效果。以期为护理管理者降低护士离职率及离职意愿,减少护理人力资源流失提供参考依据。研究方法:采用便利抽样法,纳入江苏省内4所综合性医院(其中,二级甲等综合性医院及三级甲等综合性医院各2所),使用研究小组自行设计的问卷,对纳入医院护理部主任进行问卷调查,了解纳入医院常规护士留职对策。随后,在护理人员综合激励模型的指导下,结合纳入医院实际情况,通过文献研究和小组讨论对护理人员留职对策基本框架进行细化,形成以职业生涯管理、绩效管理和压力管理为主要内容的护理人员综合留职对策。最后,将研究纳入的二级医院与三级医院分别分为试验组和对照组。以护理人员离职意愿为样本量计算指标,根据两样本均数比较的样本量估算结果,二级医院试验组和对照组至少需各抽取177名护士,三级医院试验组和对照组至少需各抽取155名护士。本研究采用整群抽样法,按纳入医院各科室上一年度护理人员实际离职率排行情况,由高到低抽取护理单元,直至满足样本量需求为止。最终抽取二级医院ICU、急诊、儿科、妇产科、神经外科、骨科、心血管内科7个科室,共计10个护理单元;三级医院ICU、急诊、儿科3个科室,共计9个护理单元。选取护理单元中符合纳入标准的护士作为研究对象,最终确定二级医院试验组187人,对照组190人;三级医院试验组194人,对照组187人。并于2018年1月~2018年12月使用护理人员综合留职对策对试验组进行为期1年的干预。干预期间,对照组医院继续实施各自常规护士留职对策。研究者分别于干预开始前、干预实施6个月后及干预实施12个月后,收集纳入医院两组护理人员离职率、离职意愿、工作满意度、工作环境满意度、组织承诺水平及职业倦怠程度等相关资料,分析并评价护理人员综合留职对策的应用效果。研究结果:1.制定的护理人员综合留职对策:包括:职业生涯管理、绩效管理、压力管理三个维度。其中,职业生涯管理包括:职业分析,个人分析,确定目标与路线,提供职业发展机会,考核评价;绩效管理包括:进行科学的工作分析,完善绩效考评标准,将绩效考评结果与护士评优、晋升、薪酬分配、职业发展及岗位聘用挂钩;压力管理包括:压力调节知识讲座,压力事件点评,建立自我管理-科室管理-护理部管理的三级网络机制,同伴支持。2.二级医院干预结果:实施护理人员综合留职对策前,试验组和对照组护理人员实际离职率差异无统计学意义(P>0.05);离职意愿、工作满意度、工作环境满意度总分及其各维度得分差异无统计学意义(P>0.05);除规范承诺维度外,组织承诺总分及其各维度得分差异无统计学意义(P>0.05);职业倦怠量表各维度得分差异无统计学意义(P>0.05)。对策实施6个月后,试验组护理人员实际离职率与对照组差异无统计学意义(P>0.05);试验组护理人员离职意愿总分及其各维度得分均低于对照组,且差异具有统计学意义(P<0.05);除福利待遇维度外,试验组护理人员工作满意度总分及其各维度得分均高于对照组,但仅工作满意度总分及家庭/工作的平衡、社交机会、专业发展机会、工作被称赞和被认可、对工作的支配及参与决策的机会维度得分差异具有统计学意义(P<0.05);除护士参与医院事务维度外,试验组护理人员工作环境满意度总分及其各维度得分均高于对照组,但差异无统计学意义(P>0.05);试验组护理人员组织承诺总分及其各维度得分均高于对照组,但仅组织承诺总分及规范承诺、机会承诺维度得分差异具有统计学意义(P<0.05);试验组护理人员情感衰竭、去人格化维度得分低于对照组,个人成就感维度得分高于对照组,但差异均无统计学意义(P>0.05)。对策实施12个月后,试验组护理人员实际离职率低于对照组及干预实施前,且差异具有统计学意义(P<0.05);试验组护理人员离职意愿总分及其各维度得分均低于对照组,且除外在机会维度外,差异具有统计学意义(P<0.05);试验组护理人员工作满意度、工作环境满意度、组织承诺总分及其各维度得分均高于对照组,且差异具有统计学意义(P<0.05);试验组护理人员情感衰竭、去人格化维度得分低于对照组,且差异有统计学意义(P<0.05),个人成就感维度得分高于对照组,但差异无统计学意义(P>0.05)。3.三级医院干预结果:实施护理人员综合留职对策前,试验组和对照组护理人员实际离职率差异无统计学意义(P>0.05);除外在机会维度外,离职意愿总分及其各维度得分差异无统计学意义(P>0.05);除福利待遇、工作被称赞和被认可维度外,工作满意度总分及其各维度得分差异无统计学意义(P>0.05);除医护合作维度外,工作环境满意度总分及其各维度得分差异无统计学意义(P>0.05);除机会承诺维度外,组织承诺总分及其各维度得分差异无统计学意义(P>0.05);除去人格化维度外,职业倦怠量表各维度得分差异无统计学意义(P>0.05)。对策实施6个月后,试验组护理人员实际离职率与对照组差异无统计学意义(P>0.05);试验组护理人员离职意愿总分及其各维度得分与对照组差异无统计学意义(P>0.05);工作满意度总分及其各维度得分均高于对照组,且差异具有统计学意义(P<0.05);工作环境满意度总分及其各维度得分均高于对照组,且除高质量护理服务维度外,差异具有统计学意义(P<0.05);组织承诺总分及其各维度得分均高于对照组,但仅组织承诺总分及感情承诺、经济承诺、机会承诺维度得分差异具有统计学意义(P<0.05);试验组护理人员情感衰竭、去人格化维度得分低于对照组,个人成就感维度得分高于对照组,且差异均具有统计学意义(P<0.05)。对策实施12个月后,试验组护理人员实际离职率较干预前略有降低,但与干预前及对照组差异均无统计学意义(P>0.05);试验组护理人员离职意愿总分及其各维度得分略低于对照组,但差异无统计学意义(P>0.05);试验组护理人员工作满意度、工作环境满意度、组织承诺总分及其各维度得分均高于对照组,且差异具有统计学意义(P<0.05);试验组护理人员情感衰竭、去人格化维度得分低于对照组,且差异具有统计学意义(P<0.05),个人成就感维度得分低于对照组,但差异无统计学意义(P>0.05)。研究结论:以护士职业生涯管理、绩效管理、压力管理为主要内容的护理人员综合留职对策能够有效降低二级医院护理人员离职意愿及实际护士离职率,提高二级医院和三级医院护理人员工作满意度、工作环境满意度及组织承诺水平,缓解护理人员职业倦怠,但其对降低三级医院护理人员离职意愿及实际护士离职率的效果并不显著。更多还原

【Abstract】 Objective:Based on the Integrated Incentive Model of nursing staff and Basic Framework for nursing staff retention strategies,established by preliminary research,to establish the integrated retention strategies for nurses and to evaluate the effect of its application.In order to provide a reference for nursing managers to reduce the turnover rate and turnover intention of nurses,promote the retention of nurses,and reduce the loss of nursing human resources.Methods:By convenience sampling,4 general hospitals(two grade II,class A hospitals and two grade III,class A hospitals)in Jiangsu Province were included.The questionnaire designed by the research group was used to conduct a questionnaire survey on the directors of the nursing department of the included hospitals to understand the conventional nurse retention strategies in the included hospitals.Then,based on the Integrated Incentive Model of nursing staff and the Basic Framework for nursing staff retention strategies,combined with the research progress at home and abroad and the actual situation of included hospitals,the research team members discussed together to establish the integrated retention strategies for nurses,which mainly includes career management,performance management and stress management.Finally,the grade II and grade III hospitals included in the study were randomized into the experimental group and the control group.Taking the turnover intention of nursing staff as the sample size calculation index,according to the sample size estimation results based on the comparison of two sample means,the experimental group and control group of grade II hospital need to draw at least 177 nurses,and the experimental group and control group of grade III hospital need to draw at least 155 nurses.By cluster sampling,the clinical departments were chosen from high to low,according to the actual turnover rate of nurses in each clinical department of the included hospitals in the previous year,until the sample size was satisfied.Finally,7 departments including ICU,emergency department,pediatrics,obstetrics and gynecology,neurosurgery,orthopedics,and cardiovascular medicine in secondary hospitals have been chosen,totaling 10 nursing units;3 departments including ICU,emergency department,pediatrics in tertiary hospitals have been chosen,totaling 9 nursing units.Select nurses who meet the inclusion criteria in the nursing unit as the research objects,and finally the experimental group of secondary hospital included 187 nurses,the control group of secondary hospital included 190 nurses;and the experimental group of tertiary hospital included 194 nurses,the control group of tertiary hospital included 187 nurses.The experimental group has been given a one-year intervention using the integrated retention strategies for nurses,from January 2018 to December 2018.During the intervention period,the control groups of the secondary hospital and the tertiary hospital carried out their conventional nurse retention strategies.All data were collected before the intervention,6 months after intervention and 12 months after intervention.The questionnaires were used to measure nurses’ turnover rate,turnover intention,job satisfaction,work environment satisfaction,organizational commitment and job burnout in order to evaluate the effect of the application of integrated retention strategies for nurses.Results:1.The integrated retention strategies for nurses:Include three dimensions: career management,performance management and stress management.Career management includes: career analysis,personal analysis,setting goals and routes,providing career development opportunities,assessment and evaluation.Performance management includes: conducting scientific work analysis;formulating performance evaluation standards;linking performance evaluation with nurses’ recommendation,promotion,salary,career development,and job hiring.Stress management includes: pressure regulation knowledge lecture,stress event reviews,establish a three-level network mechanism of self-management--clinical department management--nursing department management,peer support.2.The intervention results for secondary hospital:Before the intervention,compared between the experimental group and the control group,there is no significant difference between the two groups in turnover rate(P>0.05).The total and all dimensions scores of the turnover intention,job satisfaction,and work environment satisfaction between the two groups have no statistically significant differences(P>0.05).Except the normative commitment,the total and all dimensions scores of the organizational commitment between the two groups have no significant differences(P>0.05).The scores of all dimensions of job burnout between the two groups have no statistically significant differences(P>0.05).Six months after intervention,there is no significant difference between the turnover rate in the experimental group and the control group(P>0.05).The total and all dimensions scores of the turnover intention in the experimental group are lower than the control group(P<0.05).Except the extrinsic rewards,the total and all dimensions scores of job satisfaction in the experimental group are higher than the control group,but only the total score of job satisfaction and family/work balance,interaction,professional opportunities,praise/recognition,control/responsibility have statistically significant(P<0.05).Except nurse participation in hospital affairs,the total and all dimensions scores of work environment satisfaction in the experimental group are higher than the control group,but the differences have no statistically significant(P>0.05).The total and all dimensions scores of the organizational commitment in the experimental group are higher than the control group,but only the total score of organizational commitment and the normative commitment and opportunity commitment have statistically significance(P<0.05).The scores of emotional exhaustion and depersonalization in the experimental group are lower than the control group,and the score of self-achievement is higher than the control group,but all the differences have no statistically significant(P>0.05).Twelve months after intervention,the turnover rate in the experimental group is lower than the control group and before the intervention,and the differences have statistically significant(P<0.05).The total and all dimensions scores of the turnover intention in the experimental group are lower than the control group,and except opportunity,the differences have statistically significant(P<0.05).The total and all dimensions scores of job satisfaction,work environment satisfaction,organizational commitment in the experimental group are higher than the control group,and the differences have statistically significant(P<0.05).The scores of emotional exhaustion and depersonalization in the experimental group are lower than the control group and the differences have statistically significant(P<0.05);and the score of self-achievement in the experimental group is higher than the control group,but the differences have no statistically significant(P>0.05).3.The intervention results for tertiary hospitals:Before the intervention,compared between the experimental group and the control group,there is no significant difference between the two groups in turnover rate(P>0.05).Except opportunity,the total and all dimensions scores of the turnover intention have no statistically significant differences(P>0.05).Except extrinsic rewards and praise/recognition,the total and all dimensions scores of job satisfaction have no statistically significant differences(P>0.05).Except nurse–physician relations,the total and all dimensions scores of work environment satisfaction have no statistically significant differences(P>0.05).Except opportunity commitment,the total and all dimensions scores of the organizational commitment have no statistically significant differences(P>0.05).Except the depersonalization dimension,the scores of other dimensions of job burnout between the two groups have no statistically significant differences(P>0.05).Six months after intervention,there is no significant difference between the turnover rate in the experimental group and the control group(P>0.05).The total and all dimensions scores of the turnover intention in the experimental group have no statistically significant differences compared with the control group(P>0.05).The total and all dimensions scores of job satisfaction are higher than the control group,and the differences have statistically significant(P<0.05).The total and all dimensions scores of work environment satisfaction in the experimental group are higher than the control group,and except the nurse foundations for quality of care,the differences have statistically significant(P<0.05).The total and all dimensions scores of the organizational commitment in the experimental group are higher than the control group,but only the total score of the organizational commitment and the emotional commitment,financial commitment and opportunity commitment have statistically significant(P<0.05).The scores of emotional exhaustion and depersonalization in the experimental group are lower than the control group,and the score of self-achievement is higher than the control group,and the differences have statistically significant(P<0.05).Twelve months after intervention,the turnover rate in the experimental group is lower than the control group and before the intervention,but the differences have no statistically significant(P>0.05).The total and all dimensions scores of the turnover intention in the experimental group are lower than the control group,but the differences have no statistically significant(P>0.05).The total and all dimensions scores of job satisfaction,work environment satisfaction,organizational commitment in the experimental group are all higher than the control group,and the differences have statistically significant(P<0.05).The emotional exhaustion and depersonalization scores in the experimental group are lower than the control group,and the differences have statistically significant(P<0.05);and the score of self-achievement in the experimental group is lower than the control group,but the differences have no statistically significant(P>0.05).Conclusions:The integrated retention strategies for nurses with career management,performance management and stress management can effectively reduce the turnover rate and turnover intention of nurses in secondary hospitals;and improve job satisfaction,work environment satisfaction,organizational commitment and relieve job burnout of nurses in secondary and tertiary hospitals.However,its effect on reducing the turnover rate and turnover intention of nurses in tertiary hospitals is not significant.更多还原