臺灣博碩士論文加值系統

台灣地區之公立醫院，一方面因為曾所肩負的社會責任及角色的改變、另一方面因為全民健保制度下醫療產業的激烈競爭，在經營型態上亟需調整，例如以合併的方式整合核心能力、降低行政成本。而組織的改變對於組織員工普遍會引起工作不安全感，並進一步造成工作態度上的影響；在醫院當中，佔員工最大比例的人員即為護理人員。
本研究之研究對象為高雄市立聯合醫院，合併前分別為高雄市立大同醫院與高雄市立婦幼綜合醫院，兩院於2003年初合併。本研究於合併前夕2002年底發放第一次問卷，合併後一年，即2003年底再次發放問卷，以問卷調查護理人員工作不安全感及各工作態度之狀況。針對兩次所得之問卷，一方面探討醫院合併之工作不安全感對於護理人員工作態度的影響，另一方面也比較了兩個不同醫院之護理人員工作態度之差異。研究結果發現：
1. 護理人員之工作不安感愈高，則工作滿足愈差。
2. 護理人員之工作不安全感及各工作態度，在不同個人特徵（所屬醫院、年齡、婚姻狀況、教育程度、服務年資、職階、編制）之情況下有不同之表現。
3. 護理人員之工作不安全感對於工作滿足、組織承諾及離職傾向之影響，在不同醫院之間有顯著差異；亦即護理人員之工作不安全感對工作滿足，受到所屬醫院的干擾效果之影響。
4. 護理人員之工作不安全感對於工作滿足之影響，在合併前或合併後也存在顯著差異；亦即護理人員之工作不安全感對工作滿足，受到合併前後的干擾效果之影響。

The public hospitals in Taiwan are facing the change of public responsibilities that they used to have and on the other hand encountering the fierce competition caused by National Health Insurance. As a consequence of this, public hospitals need to adjust their managerial model, like mergers for example, in order to coordinate their core competence and lower their cost in administration. However, the changes of organizations will cause the job insecurity of employees and further to affect their working attitudes. In hospitals, nursing staff forms the biggest proportion of employees.
In this study, we examined the merger of Kaohsiung Municipal United Hospital in 2003. We investigated the job insecurity and working attitudes of nursing staff by questionnaires in the end of 2002 (before the merger) and in the end of 2003 (one year later of the merger) separately. By analyzing those questionnaires we explored the influences of job insecurity on working attitudes, and we also compared the differences of nursing staff’s working attitudes in two hospitals. The findings are:
1. The more job insecurity that nurses got, the worse their job satisfaction will be.
2. The job insecurity and working attitudes of nursing staff will be different based on their different personal characteristics, including the hospital they belonged to, the ages, marriage status, education, levels of position, and their contract types.
3. The influences of job insecurity on job satisfaction, organizational commitment, and intention to quit will be different based on different hospitals.
4. The influences of job insecurity on job satisfaction will be different before and after merger.

第一章 緒論……………………………………………………………1
第一節 研究背景與動機…………………………………………………………1
第二節 研究目的……………………………………………………………………3
第二章 文獻探討……………………………………………………….5
第一節 合併之意義與醫院合併…………………………………………………….5
第二節 工作不安全感……………………………………………………………….6
第三節 工作態度……………………………………………………………………11
第四節 台灣地區護理人員之現況…………………………………………………22
第五節 醫院背景……………………………………………………………………23
第三章 研究方法………………………………………………………26
第一節 研究架構與假設……………………………………………………………26
第二節 研究變項的操作型定義與衡量……………………………………………31
第三節 資料蒐集方法及樣本特性分析……………………………………………40
第四節 資料分析方法………………………………………………………………46
第五節 研究限制……………………………………………………………………47
第四章 研究結果………………………………………………………49
第一節 各研究變項之描述性統計結果……………………………………………49
第二節 工作不安全感、工作態度與個人變項的變異數分析……………………53
第三節 工作不安全感與各項工作態度的相關性及迴歸分析……………………66
第四節 不同醫院與合併前後對各項工作態度之影響……………………………68
第五章 結論與建議……………………………………………………93
第一節 結論…………………………………………………………………………93
第二節 建議………………………………………………………………………103
參考文獻………………………………………………………………107
附錄……………………………………………………………………114

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