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題名：影響護理人員任務績效與離職意向因素之跨層次研究
作者：劉淑芬
作者(外文)：Doresses Liu
校院名稱：國立中央大學
系所名稱：人力資源管理研究所
指導教授：黃同圳
學位類別：博士
出版日期：2015
主題關鍵詞：組織結構；轉換型領導風格；病人安全文化；任務績效；離職意向；Organizational Structure；Transformational Leadership Style；Task Performance；Turnover Intention；Hierarchical Linear Model
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近年來護理人力短缺，探討影響護理人員任務績效與離職意向因素，為全球人力資源管理之重要議題。
目的:透過跨層次模式，探究群體層次組織結構構成因素(正式化、標準化、集權化)、轉換型領導風格、以及個人層次護理人員病人安全文化知覺感受，對於護理人員任務績效與離職意向之影響，並釐清病人安全文化在轉換型領導風格對護理人員離職意向及任務績效間之中介效果。
方法:採自陳式問卷方式收集資料，依醫院評鑑等級與中央健保署分區，隨機取樣，以單位護理主管及護理人員為研究對象，共回收非公立醫院經營管理之23家醫院，有效問卷1521份，總回收率92.18%(護理長147份、護理人員1374份)，以HLM檢測跨層級效果。
結果:病人安全文化之正向知覺對離職意向具有負向影響，對任務性績效具有正向影響。護理長的轉換型領導型態五個構面，對護理人員病人安全文化之知覺、任務性績效具有正向影響，護理人員離職意向為負向影響。組織結構正式化會調節病人安全文化之知覺，高正式化對於任務性績效之正向影響與離職意向負向影響明顯高於低正式化；組織結構在較低集權化，病人文化對任務績效影響較強，明顯高於高集權化。相似結果也呈現在組織結構標準化越高，病人安全文化對護理人離職意向負向影響更明顯。標準化在病人安全文化與任務績效之間的調節作用並不顯著。集權化則是在病人安全文化與離職意向之間亦無顯著調節效果。病人安全文化對於轉換型領導風格與護理人員離職意向及任務績效之影響，具有完全中介效果。
結論:研究結果界定組織結構構成構面調節變項效果與釐清病人安全文化中介角色。增進組織結構構成因素與病人安全文化，對於護理人員任務績效與離職意向影響之知識。
Due to severe nursing shortage in recent years, investigating the factors associated with nurses’ task performance and turnover intention has become a critical task in human resource management worldwide.
The study using a multi-level design aimed to examine the effects of the three dimensions of organizational structure (formalization, standardization, centralization) and transformational leadership style at the group level, as well as the individual level of perception of patient safety culture on nurses’ task performance and turnover intention. In addition, the mediating role of patient safety culture on the relationship between transformational leadership and nurses’ turnover intention and task performance were also explored.
Data were collected from the head nurses and nurses using self-report questionnaires. A random sampling scheme according to the distribution ratio and rank of hospital accreditation was used. The sample consisted of 1521 participants from 23 hospitals, with an overall response rate of 92.18% (147 head nurses and 1347 nurses). The cross-level effects was examined by the HLM
The results indicated that patient safety culture had a negative impact on nurses’ turnover intention and a positive impact on task performance. The five dimensions of transformational leadership style in head nurses had a positive impact on nurses’ perception of patient safety culture, task performance and negative impact on nurses’ turnover intention.
Furthermore, formalization of organizational structure moderated the perception of patient safety culture: higher formalization had significantly larger negative impact on nurses’ turnover intention and positive impact on task performance stronger than lower formalization. Lower centralization positive impact on task performance is stronger than higher centralization, and then higher standardization has negative impact on nurses’ turnover intention as well as higher formalization.
However, the moderating effect of standardization on the relationship between patient safety culture and nurses’ task performance and that of centralization on the relationship between patient safety culture and nurses’ turnover intention were not statistically significant.Patient safety culture has a completely mediating effect on the relationship between transformational leadership style and task performance and that between transformational leadership and turnover intention.
The results from this study provided insights into the effects of organizational structural factors and patient safety culture on nurses’ task performance and turnover intention.
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