探討護理人員工作滿意度：國際比較與政策建議

Abstract

背景：工作滿意度是護理師對個人在護理專業表現、工作調適及對執業環境的滿意程度。面對全球人口老化，世界衛生組織估計健康照護人力資源非常欠缺。護理人員陸續移民到有錢國家工作，讓貧窮國家人力更為短缺。台灣護理人員工作負荷大，與國際比較分析將有助於避免護理人力流失，發展有競爭力之護理人力策略。 方法：採兩階段研究設計，第一階段以系統性文獻回顧，廣泛蒐集共計100篇有關全世界各國有關護理人員工作滿意度量性研究成果，彙整104筆工作滿意度之平均數，將之百分位數化以利進行國家之間比較，並與各國國民生產毛額(GDP)進行相關分析。第二階段採次籍資料分析2016年的橫斷式研究設計，以立意取樣方式選取六家不同層級的醫院，由497位護理師完成問卷填寫，然後進行描述性與推論性統計分析。 結果：統合分析2009~2019年十年間護理人員工作滿意度之國內外文獻，共計100篇，有104筆各國護理人員工作滿意度之量性資料，進行統合分析，一共蒐集到38國家，總計71429護理人員，全世界護理人員工作滿意度總平均為64.185(SD 8.29)，與該國人均GDP之相關係數為0.374 (p=0.021)，刪除寮國偏高的分數，37國家亦顯示相關係數為0.440( p=0.006)。顯示人均GDP越高該國護理人員之工作滿意度越高。台灣一共有19篇研究，綜合平均工作滿意度為67.82。我國2016資料次級分析顯示，護理人員工作滿意度為71.34，與各國比較為中上程度，迴歸分析顯示主要影響因素為縣市、學歷、工作年資，解釋變異量10.1%。 結論/實務應用：全世界護理人員工作滿意度為中等，我國護理人員滿意度略高於世界之平均值，本研究發現國家總體經濟狀況較優的護理人員工作滿意度較高。本土資料顯示雖然個人因素對工作滿意度有些許影響，若能改善國家整體經濟實力，研擬健康政策，營造優質護理職場，將能讓護理人員工作滿意度提升，俾能提升留任意願、減少離職與流失率，以確保國人健康照護之品質。

Background: Job satisfaction of nurses is the degree to which a registered nurse is satisfied with the individual's job performance, job adjustment, and the practice environment in the nursing profession. Faced with an aging global population, the World Health Organization estimates that human resources for health care will be confronting the considerable threat. Nurses have gradually migrated to work in richer countries, which has resulted in a shortage of manpower in poor countries. Currently, the workload of nurses in Taiwan is heavy. The international comparison in this study can help prevent the loss of nursing manpower and develop a competitive human resources strategy for nursing staff. Methods: A two-stage study design was designed. In the first stage, a systematic review was conducted, and a total of 100 quantitative research results on the job satisfaction of nurses in various countries around the world were retracted. The means of job satisfaction of nurses were standardized for global comparison, and correlation with the Gross Domestic Product (GDP) of each country was analyzed. In the second stage, secondary data analysis from a cross-sectional study design in 2016 was adopted. Six hospitals of varying levels were selected by purposive sampling. A total of 497 nurses completed the questionnaires, and the data were analyzed using descriptive and inferential statistical analysis. Results: This systematic review and meta-analysis of nursing job satisfaction in the previous ten years (from 2009 to 2019) over 38 countries indicated that overall average job satisfaction of nurses is 64.185 (SD 8.29) among a total of 71429 nurses. Correlation with the national per capita GDP showed a coefficient 0.374 (p = 0.021). Deleting higher scores in Laos, 37 countries also showed a higher significant correlation coefficient of 0.440 (p = 0.006). The results indicated that the higher the national per capita GDP, the higher the job satisfaction of nurses in the country. Nineteen Taiwan studies showed an overall average job satisfaction of 67.82. Secondary analysis of Taiwan’s data from 2016 showed that the job satisfaction of the nurses is 71.34, which is medium to high compared with other countries. Regression analysis showed that 10.1% of various is explained by main influencing factors such as counties, education, and years of nursing work. Conclusion and implications: Nurses around the world showed medium job satisfaction, with nurses in Taiwan showing a slightly higher average satisfaction. This study found that nurses with higher overall economic status in the country have higher job satisfaction. Although Taiwan’s data show that personal factors slightly impact job satisfaction, improvement in the country's overall economic strength, development health policies, and a high-quality working environment for nurses can increase their job satisfaction, increase their willingness to stay and reduce turnover rates, thereby ensuring the quality of health care for people in Taiwan.