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姓名	劉淑芬(Doresses Liu)  查詢紙本館藏	畢業系所	人力資源管理研究所
論文名稱	影響護理人員任務績效與離職意向因素之跨層次研究 (Factors influencing nurses’ task performance and turnover intention: A multi-level study)
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摘要(中)	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。
摘要(英)	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.
關鍵字(中)	★ 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	關鍵字(英)	★ Organizational Structure ★ Transformational Leadership Style ★ Task Performance ★ Turnover Intention ★ Hierarchical Linear Model
論文目次	中文摘要 i Abstract ii 誌 謝 iii 目 錄 iv 圖目錄 vi 表目錄 viii 一、緒論 1 1-1 研究背景 1 1-2 研究目的 11 二、文獻回顧 17 2-1 離職意向、任務績效 17 2-2 病人安全文化與離職意向、任務績效 25 2-3 轉換型領導、病人安全文化與離職意向、任務績效 32 2-4 組織結構、病人安全文化與離職意向、任務績效 39 2-5 病人安全文化的中介角色 47 三、研究方法 52 3-1 抽樣方法 52 3-2 資料蒐集 54 3-3 群體層次分組標準 54 3-4 量表設計 58 3-5 資料分析方法 64 四、研究結果 67 4-1 樣本結構 67 4-2 假設檢驗 72 五、結論與建議 111 5-1 研究結果討論 111 5-2 結論 123 5-3 管理意涵 125 5-4 學術意涵 127 5-5 研究限制 128 5-6 未來研究建議 129 中文參考文獻 131 英文參考文獻 136 附 錄 155 一、護理長問卷 155 二、護理人員問卷 157 圖目錄 圖1 The JOINT conceptual model for explaining and predicting absebteeism and turnover among nurses 24 圖2 General path model relating value congruence, psychological need fulfillment, and employee attitudes 24 圖3 社會化過程模式 28 圖4 主動關懷模式 35 圖5 組織文化如何影響員工績效與工作滿足 47 圖6 研究架構圖 51 圖7 正式化調節病人安全文化之知覺對任務績效影響 91 圖8 集權化調節病人安全文化之知覺對任務績效之影響 91 圖9 正式化調節病人安全文化之知覺對離職意向之影響 95 圖10 標準化調節病人安全文化之知覺對離職意向之影響 95 圖11 病人安全文化之知覺中介理想的特質與任務績效 102 圖12 病人安全文化之知覺中介理想的行為與任務績效 102 圖13 病人安全文化之知覺中介靈感的激勵與任務績效 102 圖14 病人安全文化之知覺中介才智的刺激與任務績效 103 圖15 病人安全文化之知覺中介個別關懷與任務績效 103 圖16 病人安全文化之知覺中介理想的特質與離職意向 109 圖17 病人安全文化之知覺中介理想的行為與離職意向 109 圖18 病人安全文化之知覺中介靈感的激勵與離職意向 110 圖19 病人安全文化之知覺中介才智的刺激與離職意向 110 圖20 病人安全文化之知覺中介個別關懷與離職意向 110 表目錄 表1 醫療院所數按型態別 14 表2 醫院特殊病床數按病床別 15 表3 平均每家醫院每日醫療服務量 15 表4 國內外護理人員照護病人數比較 16 表5 護理人員分組 56 表6 護理長分組 57 表7 樣本代表性檢定(醫院評鑑等級) 68 表8 樣本代表性檢定(中央健保署分區) 68 表9 護理長基本資料描述性統計 69 表10 護理人員基本資料描述性統計 70 表11 臨床服務病床屬性分組描述性統計(團體層級) 71 表12 護理人員描述性統計(個人層級) 72 表13 變數描述性統計及相關分析(護理人員層級) 73 表14 變數描述性統計及相關分析(群體層級) 74 表15 離職意向與任務性績效零模型指標 76 表16 病人安全文化之知覺對離職意向及任務性績效 78 表17 轉換型領導對病人安全文化之知覺 81 表18 轉換型領導對病人安全文化之知覺(續) 82 表19 轉換型領導對離職意向 84 表20 轉換型領導對離職意向(續) 85 表21 轉換型領導對任務性績效 87 表22 轉換型領導對任務性績效(續) 88 表23 病人安全文化之知覺、組織結構化對任務性績效 90 表24 病人安全文化之知覺、組織結構化對離職意向 94 表25 轉換型領導、病人安全文化之知覺對任務性績效 99 表26 轉換型領導、病人安全文化之知覺對任務性績效(續) 100 表27 轉換型領導、病人安全文化之知覺對離職意向 107 表28 轉換型領導、病人安全文化之知覺對離職意向(續) 108
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指導教授	黃同圳(Tung-chun Huang)	審核日期	2015-12-7
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